HEMATOPOEISIS 6. Which of the following does not accurately 11.

In what area of the bone marrow does

1. What is the first type of cell produced by the describe hematopoietic growth factors? hematopoiesis take place?
developing embryo? A. Bind to target cell receptors to express activity A. Cords
A. Erythrocyte B. Action of majority is lineage restricted B. Endosteum
B. Granulocyte C. May promote or suppress cell death C. Endothelium
C. Lymphocyte D. Can stimulate or inhibit cell D. Sinuses
D. Thrombocyte Proliferation
12. Bone marrow cellularity refers to the ratio of
2. What percentage of tissue located in the bone 7. In the third month of gestation, what is the A. Red cell precursors to white cell
marrow cavities of adults is fat? primary site of hematopoiesis? precursors
A. 10% A. Liver B. Hematopoietic tissue to adipose tissue
B. 25% B. Marrow of long bones C. Granulocytic cells to erythrocytic cells
C. 50% C. Spleen D. Extravascular tissue to intravascular Tissue
D. 75% D. Yolk sac
13. Interleukins and colony stimulating factors
3. Which of the following is not characteristic of 8. The mechanism that relays information about are cytokines produced by
pluripotent hematopoietic stem cells? tissue oxygen levels to erythropoietin-producing A. B lymphocytes and erythrocytes
A. Possess self-renewal ability sites is located in the B. Erythrocytes and thrombocytes
B. Produce progenitor cells committed to A. Brain C. Monocytes and T lymphocytes
a single cell lineage B. Kidney D. Neutrophils and monocytes
C. Express the stem cell marker CD 13 C. Liver
D. Are morphologically unrecognizable D. Spleen 14. What is the approximate total blood volume
in an adult?
4. In an adult, what are the two best areas for 9. Antigen-independent lymphopoiesis occurs in A. 1L
obtaining active bone marrow by aspiration? primary lymphoid tissue located in the B. 2L
A. Vertebra, tibia A. Liver and kidney C. 6L
B. Sternum, vertebra B. Spleen and lymph nodes D. 12L
C. Anterior iliac crest, tibia C. Peyer's patches and spleen
D. Posterior iliac crest, sternum D. Thymus and bone marrow 15. The myeloid progenitor cell can produce cells
committed to
5. What is the normal ratio of myeloid to 10. Programmed cell death is called A. Granulocytic, erythrocytic, monocytic, or
erythroid precursors in bone marrow (M:E ratio)? A. Necrosis megakaryocytic lineages
A. 1:1 B. Apoptosis B. Granulocytic, monocytic, lymphocytic, or
B. 1:3 C. Cellular senescence megakaryocytic lineages
C. 4:1 D. Terminal differentiation C. Erythrocytic, granulocytic, monocytic, or
D. 8:1 lymphocytic lineages
D. Erythrocytic, granulocytic, lymphocytic, or D. Pituitary hormone that controls platelet B. Binding of free hemoglobin by transport
megakaryocytic lineages sequestration by the spleen proteins
C. Incorporation of iron into protoporphyrin IX
16. The largest hematopoietic cells in normal 20. When the hepatic phase of fetal life is D. Removal of abnormal red cells by the spleen
bone marrow are reactivated in an adult, hematopoiesis can be
A. Osteoblasts termed 25. Hemoglobin forms that are incapable of
B. Osteoclasts A. Myeloid or medullary oxygen transport include
C. Megakaryocytes B. Myeloid metaplasia or extramedullary A. Deoxyhemoglobin and oxyhemoglobin
D. Plasma cells C. Myelophthisis or myelodysplasia B. Oxyhemoglobin and carboxyhemoglobin
D. Mesoblastic or mesenchymal C. Carboxyhemoglobin and methemoglobin
17. When evaluating a bone marrow aspirate D. Methemoglobin and deoxyhemoglobin
smear, which finding is considered abnormal? ERYTHROCYTES
A. A predominance of granulocyte precursors as 21. What is the average life span of a normal red 26. The majority of iron found in an adult is a
compared to nucleated red cells blood cell? constituent of
B. Detection of stainable iron in macrophages A. 1 day A. Ferritin
and erythroid precursors with Prussian blue B. 10 days B. Myoglobin
C. An average of three megakaryocytes seen per C. 60 days C. Hemoglobin
low power (10X) field D. 120 days D. Peroxidase
D. The presence of 10% myeloblasts on the cell
differential count 22. The Na+-K+ cation pump is an important 27. A senescent red blood cell is one that has
mechanism in keeping the red blood cell intact. A. Been hemolyzed
18. As most blood cell lines mature, which of the Its function is to maintain a high level of B. Lived its life span
following is characteristic? A. Intracellular Na+ C. Become deformed
A. Cell diameter increases B. Intracellular K+ D. Lost its mitochondria
B. Nucleus to cytoplasm ratio (N:C) decreases C. Plasma Na+
C. Nuclear chromatin becomes less condensed D. Plasma K+ 28. What red cell morphologic abnormality is
D. Basophilia of the cytoplasm increases described by the term "poikilocytosis"?
23. Which of the following depicts the structure A. Variations in size
19. Which of the following describes of the hemoglobin molecule? B. Deviations from normal shape
thrombopoietin (TPO)? A. Two heme groups, two globin chains C. Presence of inclusions
A. Renal hormone that regulates marrow red cell B. Four heme groups, two globin chains D. Alterations in hemoglobin concentration
production C. Two heme groups, four globin chains
B. Marrow hormone secreted by developing D. Four heme groups, four globin chains 29. Howell-Jolly bodies are composed of
megakaryoblasts A. DNA
C. Hormone produced by the liver that stimulates 24. Which of the following describes the process B. Iron
megakaryopoiesis known as culling? C. Reticulura
A. Release of red cells from the bone marrow D. RNA
30. When spherocytes are reported, what is D. Alkaline pH favors absoiption. 39. Periods of intense erythropoietin activity
observed on the peripheral blood smear? cause premature release of marrow reticulocytes
A. Red cells without a central pallor 35. What term describes a mature red blood cell into the blood. Which of the following is not true
B. Red cells with blunt projections that contains iron granules or deposits? of these early reticulocytes?
C. Red cells with sharp projections A. Siderosome A. Loss of residual RNA occurs immediately upon
D. Red cells with intracellular rod-shaped crystals B. Sideroblast marrow release
C. Ringed sideroblast B. Circulate longer than usual before reaching
31. The red cells found in lead poisoning D. Siderocyte maturity
characteristically exhibit coarse granules C. May be termed shift or stress reticulocytes
composed of that are reported as 36. Which of the following is associated with a D. Show diffuse basophilia with Wright's stain
A. Precipitated hemoglobin; Pappenheimer "shift to the left" in the oxygen dissociation curve
bodies of hemoglobin? 40. Which of the following inclusions is only
B. Aggregated ribosomes; basophilic stippling A. Decreased pH and elevated temperature visible with supravital staining?
C. Nuclear fragments; Pappenheimer bodies B. Decreased oxygen affinity A. Basophilic stippling
D. Excess iron deposits; basophilic stippling C. Decreased oxygen release B. Cabot rings
32. Rouleaux of red blood cells when seen in the D. Presence of 2,3-bisphosphoglycerate C. Heinz bodies
monolayer of a blood smear is characteristic of (2,3-BPG) D. Pappenheimer bodies
A. Hypersplenism
B. Hypogammaglobulinemia 37. Which of the following statements does not 41. The presence of schistocytes on the
C. Cold hemagglutinin disease characterize erythropoietin (EPO)? peripheral blood smear is commonly associated
D. Multiple myeloma A. Transforms the CFU-E into the earliest with
recognizable RBC precursor A. Increased iron mobilization
33. Which of the following is most frequently B. Increases the rate of red blood cell production B. Increased red cell destruction
associated with the inclusion bodies seen in by the bone marrow C. Decreased erythropoietin activity
Color Plate !•? C. Shortens the maturation time of developing D. Decreased red cell proliferation
A. Iron overload state erythroid precursors
B. Post-transfusion D. Decreases stimulation of erythropoiesis when 42. Which of the following may be a sign of
C. Post-splenectomy cellular hypoxia increases accelerated bone marrow erythropoiesis?
D. Iron-deficient state A. Hypercellular marrow with a decreased
38. Which of the following factors will result in an number of RBC precursors
34. Which of the following statements about iron immediate increase in oxygen delivery to the B. Bone marrow M:E ratio of 6:1
absorption is true? tissues? C. Nucleated red cells in the peripheral
A. Absorption occurs in the ileum. A. Increased pH circulation
B. The mucosal cell always absorbs the correct B. High altitudes D. Low erythrocyte, hemoglobin, and hematocrit
amount of iron to meet needs. C. Increased hemoglobin binding of levels
C. Absorption increases when erythropoietic 2,3-BPG
activity increases. D. Increased renal release of erythropoietin
43. Microcytic, hypochromic red cells are most 48. The major adult hemoglobin requires the 53. Which protein is primarily responsible for
often associated with impaired synthesis of alpha-globin chains and transport of hemoglobin dimers resulting from
A. DNA synthesis A. Beta-globin chains intravascular hemolysis?
B. RNA metabolism B. Delta-globin chains A. Hemopexin
C. Hemoglobin synthesis C. Epsilon-globin chains B. Albumin
D. Enzyme metabolism D. Gamma-globin chains C. Hemosiderin
D. Haptoglobin
44. When in bone marrow, the nucleated red 49. Defective nuclear maturation commonly
cells present in Color Plate 21 would be staged as results in the production of red cells that are 54. The morphologic abnormality
A. Basophilic normoblasts A. Normocytic characteristically found in hemoglobinopathies is
B. Polychromatophilic normoblasts B. Hypochromic A. Elliptocytes
C. Orthochromic normoblasts C. Macrocytic B. Dacryocytes
D. Pronormoblasts D. Microcytic C. Codocytes
D. Discocytes
45. When acanthocytes are found on the blood 50. The major storage form of iron is
smear, it is usually the result of A. Ferritin 55. Where do the early and late stages of heme
A. Abnormal membrane permeability B. Transferrin synthesis occur?
B. Altered membrane lipids C. Hemosiderin A. On ribosomes
C. Mechanical trauma D. Hemachromatin B. In mitochondria
D. Polymerization of hemoglobin molecules C. In cytoplasm
51. The red cells observed on a peripheral blood D. In nucleoli
46. Which erythrocyte metabolic pathway smear show extreme anisocytosis with an equal
generates adenosine triphosphate (ATP) via number of macrocytes and microcytes. Which of 56. Spectrin is a protein that occupies a major
glycolysis? the following values correlate with this finding? role in
A. Embden-Meyerhof A. MCV 108.0 fL, RDW 14.0% A. Red cell membrane structure
B. Hexose monophosphate B. MCV 90.0 fL, RDW 25.0% B. Reducing ferric iron
C. Rapoport-Luebering C. MCV 75.0 fL, RDW 16.0% C. Red cell transport and removal of CC>2
D. Methemoglobin reductase D. MCV 88.0 fL, RDW 12.0% D. Iron recovery during hemoglobin degradation
52. Excessive extravascular red cell destruction is
47. Which of the following red blood cell associated with 57. What is the function of reduced glutathione
precursors is the last stage to undergo mitosis? A. Hemoglobinemia (GSH) in the red blood cell?
A. Pronormoblast B. Bilirubinemia A. Promotes Kreb's cycle activity
B. Basophilic normoblast C. Hemoglobinuria B. Maintains anion balance during the "chloride
C. Polychromatophilic normoblast D. Hemosiderinuria shift"
D. Orthochromic normoblast C. Neutralizes intracellular oxidants that
accumulate
D. Prevents oxygen uptake by hemoglobin
58. What does measuring the total ironbinding C. All circulating red cells, including reticulocytes, 65. A 9-month-old male was seen in the
capacity (TIBC) represent? lack enzyme activity. Emergency Department with a femur fracture
A. Amount of free iron in serum D. Splenectomy can relieve the rate of red cell that had occurred from a fall down the stairs.
B. Circulating protein-bound iron destruction. Upon physical examination, the physician noted
C. Amount of iron that transferrin can bind hepatosplenomegaly, extreme pallor, and a slight
D. Indirect measurement of iron stores 63. In regard to variant hemoglobin E, «2 arrhythmia. A complete blood count revealed
|32 26 Glu → L^s, which of the following the following:
59. Serum ferritin is a good indicator of the statements is false?
amount of A. There are two normal alpha chains.
A. Cytochrome iron B. Glutamic acid replaces lysine on position 26 of
B. Storage iron the beta chains.
C. Hemoglobin iron C. Hemoglobin E is the second most common
D. Transferrin saturation hemoglobin variant known.
D. Glutamic acid is normally found at position 26
60. Fetal hemoglobin differs from adult of the beta chain.
hemoglobin in that hemoglobin F
A. Has a lower oxygen affinity 64. Color Plate 3B shows the peripheral blood of
B. Resists elution from red cells with acid a 16-year-old female with a sporadic history of
solutions dizzy spells, fainting, and jaundice. This patient The Wright's stained blood smear showed the
C. Is no longer synthesized after birth in a normal also had a history of periodic abdominal pain findings seen in Color Plate 4B. Hemoglobin
individual related to gallstones. Upon physical examination, electrophoresis was ordered with results as
D. Has four gamma-globin chains she exhibited mild splenomegaly. Her follows:
hemoglobin was 107 g/L (10.7 g/dL), hematocrit
ERYTHROCYTE DISORDERS was 0.32 L/L (32%), red cell indices were normal,
61. Impaired DNA metabolism is characteristic of and the direct antiglobulin test was negative.
A. Hemoglobin C disease Based on history and peripheral blood
B. Iron-deficiency anemia morphology, which of the following statements is
Which condition is most likely causing the
C. Sideroblastic anemia most likely true?
hematologic abnormalities?
D. Megaloblastic anemia A. Hemoglobin S will be revealed by
A. Alpha-thalassemia major
electrophoresis.
B. Cooley beta-thalas semia maj or
62. Which of the following is associated with B. Tests to confirm iron deficiency should be
C. Hemoglobin H disease
glucose-6-phosphate dehydrogenase ordered.
D. Hereditary persistence of hemoglobin F
(G6PD) deficiency? C. An intrinsic hereditary defect of red cells
A. G6PD gene is located on the should be suspected.
66. A 14-year-old African-American male was
X chromosome. D. The anemia is secondary to spleen and
seen in the clinic for abdominal pain. A complete
B. Ongoing intravascular hemolysis occurs. gallbladder disorders.
blood count revealed the following:
 B. Heterozygous persons may be partly protected D. Glycolytic ATP production
from infection by falciparum malaria.
C. Hemoglobin S is more soluble in dithionite 74. In addition to an increase in red blood cells,
than is normal hemoglobin. which of the following is characteristic of
D. Trait conditions are generally asymptomatic polycythemia vera?
with no sickle cell formation. A. Decreased platelets, decreased granulocytes,
decreased erythropoietin level
70. The findings seen in Color Plate 6B can be B. Decreased platelets, decreased granulocytes,
found in patients with microangiopathic increased erythropoietin level
hemolytic anemia (MAHA). Which of the C. Increased platelets, increased granulocytes,
following conditions could not be responsible for increased erythropoietin level
The peripheral smear showed the red blood cell this type of red cell destruction? D. Increased platelets, increased granulocytes,
morphology seen in Color Plate 5B. What A. Disseminated intravascular coagulation (DIG) decreased erythropoietin level
condition is suggested by these findings? B. Hemolytic uremic syndrome (HUS) 75. Which of the following is not characteristic of
A. Hemoglobin E disease C. Thrombotic thrombocytopenic purpura (TTP) aplastic anemia?
B. Hemoglobin S disease D. Idiopathic thrombocytopenic purpura (ITP) A. Extramedullary hematopoiesis
C. Hemoglobin SC disease B. Bone marrow hypoplasia
D. Hemoglobin C disease 71. Which of the following blood findings does C. Absolute reticulocytopenia
not correlate with the presence of ringed D. Blood findings of pancytopenia
67. Pica is most commonly associated with which sideroblasts in the bone marrow?
of the following conditions? A. Pappenheimer bodies 76. What values would you expect to obtain on
A. Pyridoxine deficiency B. Basophilic stippling hemoglobin and hematocrit determinations
B. Lack of erythrocyte folate C. Increased total iron-binding capacity done immediately after a major hemorrhage, if
C. Iron deficiency D. Increased percent transferrin saturation hemoglobin and hematocrit values were normal
D. Porphyrias prior to the hemorrhage?
72. Which of the following conditions is not A. Both normal
68. Of the following, the leading cause of folate usually associated with marked reticulocytosis? B. Both decreased
deficiency is A. Four days after a major hemorrhage C. Hemoglobin decreased, hematocrit normal
A. Increased requirements B. Drug-induced autoimmune hemolytic anemia D. Hemoglobin normal, hematocrit decreased
B. Dietary insufficiency C. Sickle cell anemia
C. Drug inhibition D. Pernicious anemia 77. Results from a 1-day-old infant include a
D. Malabsorption hemoglobin of 201 g/L (20.1 g/dL), hematocrit of
73. Hereditary stomatocytosis is manifested 0.60 L/L (60.0%), MCV of 110.2 fL, and 4
69. Which of the following statements about physiologically by changes in nucleated red cells/100 WBCs. How should these
sickle cell syndromes is false? A. Hemoglobin oxygen affinity results be interpreted?
A. Asplenism may result from repeated sickling B. Membrane cation permeability A. The elevated hemoglobin and hematocrit
crises in the homozygous state. C. Efficiency of hemoglobin reduction values indicate possible dehydration.
B. The nucleated red cells suggest accelerated 82. Which of the following is not a cause of B. Reticulocyte count
erythropoiesis due to a hemolytic process. absolute secondary erythrocytosis? C. Direct antiglobulin test
C. Testing should be done to identify the cause of A. Defective cardiac or pulmonary function D. Urine urobilinogen level
the macrocytosis. B. High-altitude adjustment
D. No further testing is indicated. C. Dehydration secondary to diuretic use 87. Which of the following conditions is not
D. Hemoglobins with increased oxygen affinity associated with the presence of schistocytes and
78. When viewing Color Plate 1m, the red blood spherocytes?
cells with a single elongated projection are 83. A cellulose acetate hemoglobin A. Clostridial septicemia
known as and may be seen in electrophoresis (alkaline pH), performed on the B. Prosthetic heart valves
A. Acanthocytes; liver disease blood of a stillborn infant, revealed a single band C. Severe thermal burns
B. Echinocytes; liver disease that migrated farther toward the anode than did D. Aplastic anemia
C. Drepanocytes; myelofibrosis the Hb A control. What is the most likely
D. Dacryocytes; myelofibrosis composition of the stillborn infant's 88. A 30-year-old woman who has been vomiting
hemoglobin? for 3 days has a hemoglobin value of 180 g/L
79. A patient with normocytic, normochromic A. Four beta chains (18.0 g/dL) and a hematocrit of 0.54 L/L (54.0%).
anemia secondary to small cell carcinoma may be B. Four gamma chains Her results suggest the presence of
exhibiting an anemia designated as C. Two alpha and two beta chains A. Absolute erythrocytosis
A. Hemolytic D. Two alpha and two gamma chains B. Primary polycythemia
B. Megaloblastic C. Secondary polycythemia
C. Myelophthisic 84. The most likely cause of the stillborn infant's D. Relative polycythemia
D. Sideroblastic condition in question 83 is
A. Erythroblastosis fetalis 89. An excessive accumulation of iron in body
80. Idiopathic aplastic anemia is best defined as B. Rh hemolytic disease of the fetus tissues is called
a form of anemia that C. Hydrops fetalis A. Hemochromatosis
A. Has no identifiable cause D. ABO hemolytic disease of the newborn B. Erythroblastosis
B. Is caused by a physician's treatment C. Megaloblastosis
C. Follows exposure to ionizing radiation 85. Which of the following conditions show D. Acrocyanosis
D. Develops after a viral infection similar CBC and blood smear findings?
A. Beta-thalassemia major and minor 90. Abetalipoproteinemia is characterized by
81. Which of the following is a true red blood cell B. Folic acid and vitamin B12 deficiencies mild anemia and numerous on the peripheral
aplasia? C. Acute and chronic blood loss blood smear.
A. Marrow replacement anemia D. Sickle cell disease and trait A. Acanthocytes
B. Fanconi anemia B. Elliptocytes
C. Diamond-Blackfan anemia 86. Which of the following would be useful in C. Echinocytes
D. Donath-Landsteiner anemia identifying the cause of the blood profile seen in D. Stomatocytes
Color Plate 8«?
A. Osmotic fragility test
91. What is the most common cause of iron 96. What is the most likely genetic defect in the Her hemoglobin A2 level is quantified at 5%.
deficiency? hemoglobin of cells seen in Color Plate 10B? What do these findings suggest?
A. Bleeding A. Substitution of valine for glutamic acid in A. Iron-deficiency anemia
B. Gastrectomy position 6 of the alpha-globin chain B. Heterozygous alpha-thalassemia
C. Inadequate diet B. Substitution of valine for glutamic acid in C. Heterozygous beta-thalassemia
D. Intestinal malabsorption position 6 of the beta-globin chain D. Hemoglobin S/beta-thalassemia
C. Substitution of lysine for glutamic acid in
92. Which of the following does not characterize position 6 of the alpha-globin chain 101. What causes the hemolytic process in
beta-thalassemia major? D. Substitution of lysine for glutamic acid in glucose-6-phosphate dehydrogenasedeficiency
A. Transfusion-dependent anemia position 6 of the beta-globin chain following oxidant exposure?
B. Decreased alpha chains result in excess beta A. Coating of red cells by antibody
chains. 97. On what is the classification of sickle cell trait B. Osmotic pressure changes
C. Iron chelation therapy is necessary. versus sickle cell disease based? C. Complement attachment
D. Common in persons of Mediterranean A. Severity of the clinical symptoms D. Precipitation of denatured hemoglobin
ancestry B. Number of irreversibly sickled cells
(ISCs) 102. In clinically severe hereditary spherocytosis,
93. In the anemia of chronic disease, what are C. Level of compensatory hemoglobin F which of the following findings would not be
the usual serum iron and transferrin levels? D. Percentage of hemoglobin-S on found post-splenectomy?
A. Serum iron decreased, transferrin decreased electrophoresis A. Rise in the red cell count and hemoglobin level
B. Serum iron decreased, transferrin increased B. Higher number of circulating reticulocytes
C. Serum iron normal, transferrin normal 98. Which of the following is the most C. Increased number of Howell-Jolly bodies
D. Serum iron increased, transferrin increased appropriate treatment for sickle cell anemia? D. Transient elevation in the platelet count
94. In children, the most important effect of lead A. Hydroxyurea 103. Which of the following laboratory results is
poisoning is on the B. Supportive therapy not consistent with accelerated red cell
A. Liver C. Hyperbaric oxygen destruction?
B. Kidney D. Iron A. Increased serum bilirubin
C. Neurologic system B. Increased plasma hemoglobin
D. Development of erythrocytes 99. Which of the following values can be used to C. Increased serum lactate dehydrogenase
indicate the presence of a hemolytic anemia? (LD)
95. Which of the following would not result in the A. Hemoglobin level D. Increased serum haptoglobin
dual population of red cells represented in Color B. Hematocrit level
Plate 9B? C. Erythrocyte count 104. Acquired hemolytic anemias are usually due
A. Blood transfusion D. Reticulocyte count to
B. Oral iron therapy A. Extracorpuscular factors
C. Spleen removal 100. A pre-operative, 20-year-old female has a B. Defects within the bone marrow
D. Coexisting deficiencies mild microcytic anemia, with target cells and C. Intracellular factors
stippled red cells observed on the blood smear. D. Changes in hemoglobin stability
 A. Absent or reduced rate of globin-chain 112. Which of the following statements about
105. The antibody associated with paroxysmal synthesis hemoglobin C disease is false?
cold hemoglobinuria shows specificity for B. Inability to transport and release oxygen to the A. Electrophoresis shows approximately
A. ABO antigens tissues 60% hemoglobin A and 40% hemoglobin C.
B. I antigens C. Inhibition of iron chelation needed for heme B. Target cells are frequently seen on peripheral
C. P antigens biosynthesis smears.
D. Rh antigens D. Production of structurally abnormal C. Red cells may contain bar-shaped intracellular
hemoglobin variants crystals.
106. A 69-year-old male is admitted with pallor, D. The disorder is less severe than sickle cell
mild tachycardia, and difficulty walking because 109. Which of the following statements about disease.
of numbness in the extremities. His CBC reveals hereditary spherocytosis is true?
a hemoglobin of 78 g/L (7.8 g/dL), a hematocrit A. Abnormally shaped cells are produced in the 113. Which of the following is associated with
of bone marrow. sickle cells?
0.25 L/L (25.0%), and MCV of 118.5 fL. B. Cells have a decreased mean cell hemoglobin A. Increased oxygen tension promotes sickling.
This patient's symptoms and the blood findings concentration (MCHC). B. There is decreased mechanical fragility.
seen in Color Plate 11 • are most suggestive of C. Membrane loss and red cell trapping occur in C. There is increased deformability.
anemia due to a lack of the splenic microcirculation. D. Increased sickling occludes vessels.
A. Folic acid D. Red cell osmotic fragility is decreased.
B. Vitamin Bj2 114. A bone marrow M:E ratio of 4:1 would be an
C. Vitamin B6 110. Which of the following statements about expected finding for
D. Ascorbic acid hereditary elliptocytosis (HE) is true? A. Sickle cell anemia
A. Characteristic oval shape occurs in mature B. Aplastic anemia
107. A clinical laboratory scientist examined a erythrocytes. C. Beta-thalassemia major
Wright's stained peripheral smear and saw what B. Heterogeneous group of disorders linked to D. Megaloblastic anemia
appeared to be small, dark-staining granules in Rh-null individuals.
the mature erythrocytes. A second smear was C. Cellular defect involves the lipid composition 115. An elderly man with a 10-year history of
stained with Prussian blue and a positive result of the membrane. chronic lymphocytic leukemia presented with
was obtained. Based on this information, which D. HE cells are abnormally permeable to calcium. jaundice and fatigue that was attributed to a
of the following would you expect to be recent 3-gram drop in his hemoglobin. Many
abnormal? 111. Which of the following disorders is not spherocytes and polychromatophilic red cells
A. Plasma hemoglobin level commonly linked to the development of anemia were found on his Wright's stained blood smear.
B. Serum ferritin level of chronic disease? Which type of immune hemolytic anemia is most
C. Hemoglobin electrophoresis A. Persistent infections likely?
D. Test for parietal cell antibodies B. Noninfectious inflammatory disorders A. Idiopathic warm autoimmune hemolytic
C. Chronic gastrointestinal blood loss anemia
108. Hemoglobinopathies are characterized by D. Malignancy B. Secondary warm autoimmune hemolytic
anemia
C. Primary cold hemagglutinin disease 119. Which of the following is an acquired red D. Reduced red cell survival
D. Paroxysmal cold hemoglobinuria cell membrane defect that results in increased
sensitivity to complement binding? 124. The fish tapeworm Diphyllobothrium latum
116. A moderately anemic patient with A. March hemoglobinuria is associated with the development of
suspected pernicious anemia (PA) shows intrinsic B. Paroxysmal nocturnal hemoglobinuria A. Microcytic anemia
factor antibodies and a low cobalamin level. C. Paroxysmal cold hemoglobinuria B. Macrocytic anemia
Which of the following would not support the D. Methemoglobinemia C. Hemolytic anemia
diagnosis of PA? D. Hypoproliferative anemia
A. Gastric atrophy and achlorhydria 120. Which of the following is not associated
B. Oval macrocytes and Howell-Jolly bodies with acquired reversible sideroblastic anemias? 125. An increase in erythropoietin is not a normal
C. Bone marrow erythroid precursors exhibit A. Methotrexate therapy compensating mechanism in which of the
normoblastic maturation. B. Lead intoxication following conditions?
D. Elevated serum lactate dehydrogenase (LD) C. Isoniazid treatment for tuberculosis A. Renal tumors
and bilirubin levels D. Acute alcohol ingestion B. Heavy smoking
C. Cardiovascular disease
117. A cellulose acetate electrophoresis revealed 121. Which of the following statements about D. Pulmonary disease
a large band of hemoglobin in the hemoglobin S the relative anemia of pregnancy is false?
position. This band quantified at 95%. The A. It is due to a reduction in the number of 126. Thalassemias are the result of a
peripheral smear revealed 70% target cells, and erythrocytes. A. Structural defect in the heme portion of
the solubility test was negative. Based on this B. It is normocytic and normochromic. hemoglobin
information, what is the hemoglobin? C. It does not produce an oxygen deficit for the B. Quantitative defect in globin-chain synthesis
A. Hemoglobin C fetus. C. Qualitative defect in globin-chain structure
B. Hemoglobin D D. It is associated with an increase in plasma D. Change in hemoglobin solubility properties
C. Hemoglobin E volume.
D. Hemoglobin S 127. Which of the following characterizes
122. The anemia found in chronic renal failure is irondeficiency anemia?
118. A previously healthy man experiences most likely caused by A. Decreased serum iron, decreased transferrin
weakness and hemoglobinuria after taking the A. Loss of erythropoietin synthesis saturation, normal ferritin
antimalarial agent primaquine. This hemolytic B. Lack of cellular oxygen demand B. Decreased serum transferrin, decreased
attack most likely occurred because of a C. Defective iron absorption transferrin saturation, decreased ferritin
deficiency of D. Destruction of red cells by uremic metabolites C. Increased serum transferrin, decreased
A. Pyruvate kinase transferrin saturation, decreased ferritin
B. Glucose-6-phosphate dehydrogenase 123. Which of the following phrases about D. Increased serum transferrin, increased
C. 2,3-Bisphosphoglycerate aplastic anemia is false? transferrin saturation, decreased serum iron
D. Methemoglobin reductase A. Stem cell disorder
B. Risk of life-threatening infection
C. Frequent bleeding complications
128. Clinical manifestations of a homozygous D. Hexokinase deficiency 136. Which of the following does not accurately
mutation involving the beta-globin gene will describe cold autoimmune hemolytic anemia?
most likely appear 132. When iron use exceeds absorption, which of A. Red cell agglutination in extremities induces
A. During embryonic development the following occurs first? Raynaud's phenomenon.
B. In the neonate at birth A. Hemoglobin level decreases. B. It may occur secondary to Mycoplasma
C. No later than 3 weeks after birth B. Iron stores are depleted. pneumonia.
D. By 6 months of age C. Transferrin synthesis increases. C. Hemolysis is complement-mediated or via
D. Excretion of iron decreases. removal of coated cells.
129. The hemolysis associated with infection by D. The autoantibody is usually an IgG type
malaria organisms is due to the 133. The major mechanism responsible for the directed against Rh antigens
A. Release of merozoites from erythrocytes anemia of chronic disease is
B. Invasion of erythrocytes by merozoites A. Impaired release of storage iron because of 137. Which of the following represents an
C. Host's immunologic response to infected increased hepcidin levels anemia that would have a high red cell
erythrocytes B. Damaged bone marrow stem cells distribution width (RDW)?
D. Toxins produced by the malarial organism C. Immune destruction caused by red cell A. Sickle cell disease during crisis
autoantibodies B. Thalassemia minor
130. A clinical laboratory scientist received a 5 mL D. Increased erythropoietin response by C. Aplastic anemia
EDTA tube that contained 0.5 mL of committed red cell progenitor cells D. Anemia of chronic disorders
anticoagulated blood. A smear was prepared and
stained with Wright's stain. When examined 134. Which of the following is not a characteristic 138. In which of the following disorders would
microscopically, the majority of cells appeared to of the idiopathic type of sideroblastic anemia? splenomegaly not be a common finding?
have many evenly distributed, blunt spicules on A. Refractory to treatment A. Homozygous beta-thalassemia
the surface. How should this cellular appearance B. Blocks in heme synthesis are unknown B. Hereditary spherocytosis
be interpreted? C. Reversible with intramuscular vitamin Bj2 C. Hemoglobin SC disease
A. An anemic condition requiring further testing injections D. Folic acid deficiency
B. Spur cells caused by using incorrect technique D. Subtype of myelodysplastic syndromes Leukocytes
during slide preparation
C. Artifact caused by a dirty spreader slide 135. Thinning of bones and deformation of facial 139. Functionally, white blood cells are divided
D. Crenated cells caused by incorrect blood to bone structure seen in homozygous beta- into
anticoagulant ratio thalassemia is a A. Granulocytes, nongranulocytes
A. Consequence of disturbances in calcium B. Polymorphonuclears, mononuclears
131. A failure to generate sufficient ATP is metabolism C. Phagocytes, immunocytes
characteristic of red blood cells with B. Result of hyperplastic marrow activity D. Granulocytes, lymphocytes
A. Pyruvate kinase deficiency C. Secondary disorder due to immunologic
B. Glucose-6-phosphate dehydrogenase response 140. What is the largest white blood cell normally
deficiency D. Result of increased fibroclast activity found in the peripheral blood?
C. Lipoprotein deficiency A. Eosinophil
B. Neutrophil A. Myeloblasts and promyelocytes Which of the following is true?
C. Lymphocyte B. Band and segmented forms A. The percentage of lymphocytes is normal.
D. Monocyte C. The majority of marrow granulocytes B. There is an absolute lymphocytosis.
D. Myelocytes and metamyelocytes C. There is a relative lymphocytosis.
141. What is the approximate amount of time a D. There is both an absolute and a relative
granulocyte spends in the circulation before 146. A "shift to the left," when used to describe lymphocytosis.
migrating into the tissues? a cell population, refers to
A. Less than 1 day A. Increased cells in the blood due to a 150. Which of the following statements is
B. About 3 days redistribution of blood pools correct?
C. Up to 5 days B. An increase in immature blood cells following A. Hypersegmented neutrophils have four
D. More than 10 days release of bone marrow pools nuclear lobes.
C. A cell production "hiatus" or gap B. Auer rods are composed of fused primary
142. What percentage of neutrophils in the D. A higher percentage of lymphocytes than granules.
peripheral blood constitutes the circulating pool? neutrophils C. Toxic granules are prominent secondary
A. 100% granules.
B. 80% 147. Which of the following is characteristic of D. Dohle bodies are agranular patches of
C. 50% agranulocytosis? DNA.
D. 30% A. Neutrophils without granules
B. Decreased numbers of granulocytes, red cells, 151. Which of the following factors is not
143. What is the major phagocytic cell involved and platelets associated with variations in the total white
in the initial defense against bacterial C. Immature granulocytes in the peripheral blood blood cell count?
pathogens? D. Decreased numbers of granulocytes A. Age
A. Neutrophil B. Exercise
B. Eosinophil 148. Which of the following is not a characteristic C. Emotional stress
C. Basophil of T lymphocytes? D. Sex
D. Monocyte A. Secrete cytokines
B. Synthesize antibody 152. Of the following, an absolute neutrophil
144. What is the growth factor that is primarily C. Comprise majority of cells in the blood count of 1.0 X 109/L would be associated with
responsible for regulating granulocyte and lymphocyte pool A. Shortness of breath
monocyte production? D. Regulate the immune response B. Bleeding tendencies
A. Erythropoietin 149. An adult has a total white blood cell count C. Risk of infection
B. Colony stimulating factor of 4.0 X 109/L (4.0 X 103/jJiL). The differential D. No clinical symptoms
C. Interleukin count is as follows: polymorphonuclear
D. Thrombopoietin neutrophils (PMNs) 25%, bands 5%, lymphocytes 153. Which of the following statements about
65%, and monocytes 5%. The absolute value basophils is false?
145. What does the granulocyte mitotic pool in reference range for lymphocytes is 1.0—4.0 X A. Morphologically, basophils resemble tissue
the bone marrow contain? 109/L. mast cells.
B. Membrane receptors bind IgG, initiating B. Plasma cells
anaphylactic reactions. 158. Which of the following are indicators of a C. Virocytes
C. Basophilic granules contain heparin and neutrophilic response to tissue damage or D. Thymocytes
histamine. inflammatory stimuli?
D. Granules are water soluble. A. Toxic granules and Dohle bodies in the 163. Which of the following statements about
neutrophils neutrophils is false?
154. The most mature granulocyte precursor that B. Vacuoles and Barr bodies in the neutrophils A. Suppress allergic reactions caused by
can undergo mitosis is the C. Hypersegmented neutrophils and basophils
A. Myeloblast Auer rods B. Have surface receptors for IgG and
B. Promyelocyte D. Pyknotic neutrophils and Russell bodies complement components
C. Myelocyte C. Contain alkaline phosphatase and muramidase
D. Metamyelocyte 159. What is the term for cell movement through D. Act in nonspecific phagocytosis and are
blood vessels to a tissue site? destined to die
155. Production of primary granules ceases and A. Diapedesis
production of secondary granules commences B. Opsonization 164. Which of the following characteristics would
with what cell stage? C. Margination be least likely to distinguish reactive lymphocytes
A. Myeloblast D. Chemotaxis from monocytes?
B. Promyelocyte A. Sharp indentation of the cytoplasmic margin
C. Myelocyte 160. Vasodilation and bronchoconstriction are by adjacent red blood cells
D. Metamyelocyte the result of degranulation by which of the B. Presence of large azurophilic granules
following blood cells? C. Irregular, indented nuclear shape
156. Which of the following statements about A. Eosinophils D. Abundant, deeply basophilic cytoplasm
eosinophils is false? B. Monocytes
A. They contain a type of peroxidase that is C. Neutrophils 165. Which of the following can differentiate
distinct from that of neutrophils. D. Basophils metamyelocytes from other stages of
B. Eosinophilic granules contain lysozyme. granulocyte maturation?
C. Eosinophils are an important line of defense 161. On what basis can B and T lymphocytes be A. Presence of specific granules
against parasites. distinguished? B. Indentation of nucleus
D. Major basic protein is a component of A. Differences in nuclear shape C. Absence of nucleoli
eosinophil granules B. Monoclonal antibody reactions to surface and D. Color of cytoplasm
cytoplasmic antigens
157. Which of the following is characteristic of C. Cytoplasmic granularity and overall cell size 166. Lymphocyte concentrations in the
primary granules? D. Chromatin pattern in the nucleus peripheral blood are greatest during what age
A. Coated with a phospholipid membrane interval?
B. Called azurophilic or specific granules 162. Cells that produce immunoglobulins in A. 1 to 4 years
C. Contain myeloperoxidase and lactoferrin response to antigenic stimulation are designated B. 4 to 15 years
D. Present in the promyelocyte stage only A. Natural killer cells C. 16 to 40 years
D. 40 to 70 years LEUKOCYTE DISORDERS A. Pelger-Huet
171. In patients with infectious mononucleosis, B. May-Hegglin
167. Which of the following is the least likely to which blood cells are infected by the causative C. Alder-Reilly
be expressed by early B cell precursors? agent? D. Chediak-Higashi
A. SIgM, a surface membrane immunoglobulin A. Monocytes
B. CD34, a hematopoietic stem cell marker B. T lymphocytes 176. In which of the following are eosinophils not
C. TdT (terminal deoxynucleotidyl transferase), a C. B lymphocytes increased?
nuclear enzyme D. Histiocytes A. Gushing syndrome
D. CDlO(CALLA), a surface antigen B. Allergic disorders
172. Which of the following statements about C. Skin disorders
168. Which of the following statements about hairy cell leukemia is true? D. Parasitic infection
macrophages is incorrect? A. It is an acute disease, primarily affecting young
A. They are mature tissue forms of blood adults. 177. Which of the following represents the
monocytes. B. Splenomegaly is an unusual finding. principal defect in chronic granulomatous
B. They serve as antigen-presenting cells to the C. Hairy cells contain tartrate-resistant acid disease (CGD)?
immune system. phosphatase. A. Chemotactic migration
C. Their quantity of lysosomes and acid D. Hairy cells are abnormal T lymphocytes. B. Phagocytosis
hydrolases decreases during maturation. C. Lysosomal formation and function
D. They remove damaged or dying cells and 173. Based on the WHO classification system, B D. Oxidative respiratory burst
cellular debris. cell ALL (FAB type L3) and represent different
clinical presentations of the same disease entity. 178. The blood shown in Color Plate 11 • is from
169. Antigen-dependent lymphopoiesis occurs in A. Burkitt lymphoma a leukemia patient following treatment. These
secondary lymphoid tissue located in the B. Hodgkin lymphoma findings are most suggestive of therapy with
A. Liver and kidney C. Mycosis fungoides A. Corticosteroids (e.g., prednisone)
B. Spleen and lymph nodes D. Small lymphocytic lymphoma B. A folate antagonist (e.g., methotrexate)
C. Lungs and Peyer's patches C. Recombinant erythropoietin
D. Thymus and bone marrow 174. The presence of both immature neutrophils D. Chloramphenicol
and nucleated erythrocytes in the peripheral
170. Which of the following is not produced by blood is most accurately called a 179. A patient with normal hemoglobin and WBC
neutrophils during the respiratory burst? A. Neutrophilic left shift count values, a persistently elevated platelet
A. Hydroxyl radicals (OH~) B. Regenerative left shift count (over 1000 X 109/L), increased marrow
B. Hydrogen peroxide (H2O2) C. Neutrophilic leukemoid reaction megakaryocytes, and a history of frequent
C. Superoxide anion (O^~) D. Leukoerythroblastic reaction bleeding and clotting episodes most likely has
D. Myeloperoxidase A. Polycythemia vera
175. In which anomaly is a failure of granulocytes B. Chronic myelofibrosis
to divide beyond the band or twolobed stage C. Essential thrombocythemia
observed? D. Chronic myelogenous leukemia
180. An adult patient with massive splenomegaly B. Gram-negative septicemia A. Presence of a monoclonal population of large
has mild anemia, a slightly elevated WBC count, C. Human immunodeficiency virus (HIV) lymphoid cells
and an LAP score of 170. The blood smear shows D. Systemic fungal infection B. Predominance of immature B cells with
teardrop erythrocytes and leukoerythroblastosis. irregular nuclear clefts
These findings are most consistent with 185. The peripheral blood shown in Color Plate C. Circulating T cells with a convoluted,
A. Chronic myelogenous leukemia 14B is from a 69-year-old female. Her WBC count cerebriform nucleus
B. Idiopathic myelofibrosis was 83.0 X 109 cells/L (83.0 X 103/(xL) and her D. Presence of giant binucleated Reed- Sternberg
C. Primary polycythemia platelet count was normal. Based on the cell cells with prominent nucleoli
D. Primary thrombocythemia morphology and this information, what is the
most likely diagnosis? 189. In a patient with fever of unknown origin,
181. Which of the following infections does not A. Acute lymphoblastic leukemia which of the following findings is not consistent
reveal a blood picture as seen in Color B. Chronic lymphocytic leukemia with an inflammatory process?
Plate 12B? C. Waldenstrom macroglobulinemia A. Increased C-reactive protein
A. Epstein-Barr virus (EBV) D. Viral infection B. Increased albumin level
B. Bordetellapertussis (whooping cough) C. Increased fibrinogen level
C. Cytomegalovirus (CMV) 186. In which of the following is progression to D. Increased erythrocyte sedimentation rate
D. Toxoplasma gondii (toxoplasmosis) acute leukemia least likely?
A. Chronic myelogenous leukemia (CML) 190. The presence of the chromosomal
182. The most common type of chronic B. Refractory anemia with excess blasts (RAEB) abnormality t(15;17) and a high incidence of
lymphocytic leukemia (CLL) in the C. Refractory anemia with ringed sideroblasts disseminated intravascular coagulation (DIG) is
United States involves the (RARS) diagnostic of
A. Bcell D. Chronic lymphocytic leukemia (CLL) A. Acute myeloblastic leukemia without
B. NKcell 187. A Gaucher cell is best described as a maturation (FAB type Ml)
C. Tcell macrophage with B. Acute myeloblastic leukemia with maturation
D. Plasma cell A. "Wrinkled" cytoplasm due to an accumulation (FAB type M2)
of glucocerebroside C. Acute promyelocytic leukemia (FAB type M3)
183. Which of the following are characteristic B. "Foamy" cytoplasm filled with unmetabolized D. Acute myelomonocytic leukemia (FAB type
findings in Waldenstrom disease? sphingomyelin M4)
A. Increased IgA and hepatosplenomegaly C. Pronounced vacuolization and deposits of
B. Increased IgE and renal failure cholesterol 191. Which of the following is not commonly
C. Increased IgG and hypercalcemia D. Abundant cytoplasm containing storage iron found in acute myelogenous leukemias?
D. Increased IgM and blood hyperviscosity and cellular remnants A. Neutropenia
B. Thrombocytopenia
184. Which of the following would not cause a 188. Which of the following suggests a diagnosis C. Hepatosplenomegaly
total WBC count of 62.2 X 109/L (62.2 X 103/jjLL) of Hodgkin disease rather than other D. Lymphadenopathy
and the blood findings seen in Color Plate 13B? lymphoproliferative disorders?
A. Treatment with myeloid growth factors
192. The child whose blast cells are shown in C. PML/RARA 200. Which of the following is a typical finding in
Color Plate 15> has acute lymphoblastic D. JAK2 chronic leukemias at onset?
leukemia that is precursor B cell type and CALLA A. Symptoms of infection and bleeding
positive. Analysis by flow cytometry would likely 197. Which of the following statements does not B. Significant thrombocytopenia
show cells that immunophenotype for correctly describe the WHO (World Health C. Severe anemia
A. CD2,CD7 Organization) classification of hematopoietic D. Elevated leukocyte count
B. CD10,CD19 neoplasms?
C. CD13,CD33 A. Acute leukemia is defined as the presence of 201. In what condition would an LAP score of 10
D. CD14,CD34 at least 20% bone marrow blasts. most likely be found?
B. Diagnosis is based on cellular morphology and A. Bacterial septicemia
193. The patient whose bone marrow is shown in cytochemistry. B. Late pregnancy
Color Plate 16 • most likely has a(n) C. It groups lymphoid disorders into B cell, T/NK C. Polycythemia vera
A. Acute leukemia cell, and Hodgkin lymphoma. D. Chronic myelogenous leukemia
B. Chronic leukemia D. Diagnostic criteria include morphologic,
C. Myelodysplastic syndrome cytochemical, immunologic, cytogenetic, and 202. Which of the following is not associated
D. Aplastic anemia molecular features. with neutrophilia?
A. Staphylococcal pneumonia
194. Multiple myeloma is characterized by the 198. Which of the following would be least B. Cm shing inj ury
presence in urine of large amounts of helpful in distinguishing chronic myelogenous C. Infectious hepatitis
A. Cryoglobulins leukemia (CML) from a neutrophilic leukemoid D. Neoplasms (tumors)
B. IgG heavy chains reaction?
C. IgG light chains A. An extreme leukocytosis with increased 203. In which of the following would an absolute
D. Beta microglobulins neutrophilic bands, metamyelocytes, and monocytosis not be seen?
myelocytes A. Tuberculosis
195. Which of the following is not classified as a B. Leukocyte alkaline phosphatase score B. Recovery stage of acute bacterial infection
myeloproliferative disorder? C. Presence of marked splenomegaly C. Collagen disorders
A. Polycythemia vera D. Neutrophils with Dohle bodies and toxic D. Infectious mononucleosis
B. Essential thrombocythemia granulation
C. Multiple myeloma 204. Coarse PAS positivity may be found in the
D. Chronic myelogenous leukemia 199. The cytoplasmic inclusion present in the cell leukemic cells of
shown in Color Plate !?• A. Acute myeloblastic leukemia (FAB type Ml)
196. Which of the following gene mutations A. Excludes a diagnosis of acute myelogenous B. Acute lymphoblastic leukemia (FAB type LI)
correlates with the t(9;22) that is present in leukemia C. Acute myelomonocytic leukemia (FAB type
Philadelphia chromosome positive chronic B. Stains positive with leukocyte alkaline M4)
myelogenous leukemia? phosphatase (LAP) D. Acute monocytic leukemia (FAB type M5)
A. MYC/IGH C. Stains positive with myeloperoxidase (MPO)
B. BCR/ABL D. Identifies the cell as a malignant lymphoblast
205. Which of the following is not among the C. Serum and urine protein electrophoresis 214. A bone marrow with 90% cellularity and
diagnostic criteria used for classifying the D. Cytogenetic analysis of marrow cells myeloid:erythroid (M:E) ratio of 10:1 is most
myelodysplastic syndromes? characteristic of
A. Unexplained anemia refractory to treatment 210. Which of the following statements about A. Chronic myelogenous leukemia
B. Hypogranular and hyposegmented Hodgkin disease is false? B. Primary polycythemia
neutrophils A. Peak incidence occurs in young adults. C. Beta-thalassemia major
C. Abnormal platelet size and granulation B. Staging determines extent of disease and D. Aplastic anemia
D. Hypocellular bone marrow with 25% blasts treatment course.
C. Stage IV has the best prognosis. 215. A 60-year-old patient presents with extreme
206. Naphthol AS-D chloroacetate esterase D. Almost a 2:1 male predominance over females fatigue. Her blood and bone marrow findings are
(specific) is usually positive in cells, and is characteristic. as follows: severe anemia with a dual RBC
alphanaphthyl acetate esterase (nonspecific) is population, 3% marrow blasts, and numerous
useful for identifying blast cells of lineage. 211. The blast cells shown in Color Plate 18 • are ringed sideroblasts. This information is most
A. Granulocytic; monocytic CD14 and CD33 positive, Sudan black B positive, consistent with
B. Monocytic; granulocytic specific esterase positive, and nonspecific A. Refractory anemia (RA)
C. Granulocytic; lymphocytic esterase positive. Which type of acute leukemia B. Refractory anemia with ringed sideroblasts
D. Monocytic; lymphocytic is most consistent with the immunophenotyping (RARS)
and cytochemical staining results? C. Refractory anemia with excess blasts (RAEB)
207. The familial disorder featuring pseudo- A. Acute lymphoblastic leukemia, T cell type D. Chronic myelomonocytic leukemia (CMML)
Dohle bodies, thrombocytopenia, and large B. Acute erythroleukemia
platelets is called C. Acute myelomonocytic leukemia 216. Which of the following is not a mechanism
A. May-Hegglin anomaly D. Acute monocytic leukemia by which neutropenia may be produced?
B. Chediak-Higashi syndrome A. Hypersplenism
C. Pelger-Huet anomaly 212. Which type of leukemia is associated with B. Marrow injury or replacement
D. Alder-Reilly anomaly the best prognosis for a cure? C. Recent strenuous exercise
A. Chronic lymphocytic leukemia in the elderly D. Drug-induced antibodies
208. Alder-Reilly anomaly is an abnormality of B. Acute lymphoblastic leukemia in children
A. Lysosomal fusion C. Acute myelogenous leukemia in children 217. Which of the following is not a characteristic
B. Nuclear maturation D. Chronic myelogenous leukemia in young finding in polycythemia vera?
C. Oxidative metabolism adults A. Blood pancytosis
D. Mucopolysaccharide metabolism B. Increased red cell mass
213. What is the key diagnostic test for Hodgkin C. Increased erythropoietin level
209. What is the initial laboratory technique for lymphoma? D. Increased blood viscosity
the diagnosis of monoclonal gammopathies? A. Bone marrow biopsy
A. Immunologic markers of marrow biopsy cells B. Lymph node biopsy 218. In what disorder is significant basophilia
B. Cytochemical staining of marrow and C. Spinal tap most commonly seen?
peripheral blood cells D. Skin biopsy A. Hairy cell leukemia
B. Plasma cell leukemia D. They are characterized by proliferation of A. Hemoglobin S polymerizes when
C. Acute lymphoblastic leukemia malignant cells primarily involving the bone deoxygenated.
D. Chronic myelogenous leukemia marrow. B. Testing performed on a 2-day-old infant can
result in a false negative result.
219. Acute erythroleukemia (FAB type M6) is METHODOLOGY C. Sickle cell trait can be differentiated from
characterized by increased 223. What combination of reagents is used to sickle cell anemia with this test.
A. Promyelocytes and lysozyme activity measure hemoglobin? D. The test is positive in hemoglobin CHarlem
B. Marrow megakaryocytes and thrombocytosis A. Hydrochloric acid and p-
C. MaiTow erythroblasts and multinucleated red dimethylaminobenzaldehyde 227. Which of the following is not associated
cells B. Potassium ferricyanide and potassium cyanide with causing a falsely low ESR?
D. Marrow monoblasts and immature monocytes C. Sodium bisulfite and sodium metabisulfite A. Column used is slanted.
D. Sodium citrate and hydrogen peroxide B. EDTA tube is clotted.
220. The blood findings present in Color Plate 20 C. EDTA tube is one-third full.
• are from a patient with complaints of fatigue 224. The slowest-moving hemoglobin(s) on an D. EDTA specimen is 24 hours old.
and severe lower back pain. Which of the alkaline electrophoresis at pH 8.6 is(are)
following would not be typical of this disease? A. A 228. A platelet count is performed on an
A. Bone tumors of plasma cells B. A2, C,E, andO automated instrument from an EDTA blood
B. Hypercalcemia C. F sample. Smear evaluation reveals the presence
C. Progressive renal impairment D. S, D, andG of platelet clumps. The specimen is redrawn
D. Normal sedimentation rate using sodium citrate as the anticoagulant, and a
221. Myeloid metaplasia refers to 225. A patient with suspected sickle cell trait has count of 300 X 109/L is obtained. What is the
A. Displacement of normal marrow cells by negative solubility test results, but hemoglobin correct platelet count to report?
fibrous tissue electrophoresis at pH 8.6 shows an apparent A-S A. 270X109/L
B. Hematopoietic failure pattern. What is the most likely explanation? B. 300X109/L
C. Extramedullary hematopoiesis A. Patient has hemoglobin AS, and the solubility C. 330X109/L
D. Tumors (neoplasms) of the bone marrow test is incorrect. D. 360X109/L
B. Patient has hemoglobin AA, and the
222. Which of the following statements about electrophoresis is incorrect. 229. To best preserve cellular morphology,
non-Hodgkin types of lymphoma is true? C. Patient has hemoglobin AD or AG, and both differential smears from an EDTA specimen
A. Lymphadenopathy is the most common procedures are correct. should be made no more than hour(s) after
presenting symptom. D. Tests need to be repeated; impossible to collection.
B. Initially, they present as a systemic disease determine which procedure is correct. A. 1
rather than a localized tumor. B. 5
C. They are often associated with multiple bone 226. Which of the following is an incorrect C. 12
lesions. statement about the solubility test for D. 24
Hemoglobin S?
230. The blood smear made on a patient with D. 180X103/(JLL B. 0.10mm
polycythemia vera is too short. What should be C. 1.00mm
done to correct this problem? 235. The Sudan black B stain shown in Color D. 0.1 cm
A. Decrease the angle of the spreader slide. Plate 19B is a stain for
B. Increase the angle of the spreader slide. A. Glycogen 240. A WBC count is performed on a
C. Adjust the angle of the spreader slide to 45 B. Lipids hemacytometer using a 1:20 dilution. 308 cells
degrees. C. Myeloperoxidase are seen in a total area of 8 mm2. What is the
D. Use a smaller drop of blood. D. Acid phosphatase WBC count?
A. 3.8X109/L
231. The components of Wright's stain include 236. The following numbers were obtained in B. 7.7X109/L
A. Crystal violet and safranin evaluating leukocyte alkaline phosphatase (LAP) C. 15.4X109/L
B. Brilliant green and neutral red activity in neutrophils. What is the score? D. 38.5X109/L
C. New methylene blue and carbolfuchsin
D. Methylene blue and eosin 241. Which set of results indicates that an error
in measurement has occurred?
232. What is the reason for red blood cells to be A. 100
bright red and the WBC nuclei to be poorly B. 115
stained when using Wright's stain? C. 200
A. The staining time is too long. D. 215
B. The stain or buffer is too alkaline.
C. The stain or buffer is too acidic. 237. Perl's Prussian blue is a stain used to detect
D. The smear was not washed long enough. A. DNA
B. RNA
233. If 60 reticulocytes are counted in 1000 red C. Iron 242. Which of the following would not be the
blood cells, what is the reticulocyte count? D. Glycogen cause of a falsely high MCHC of 38.3 g/dL on an
A. 0.06%
automated instrument?
B. 0.6% 238. Which of the following red cell inclusions A. Hereditary spherocytosis
C. 6.0% stain with both Perl's Prussian blue and Wright's B. Lipemia
D. 60.0% stain? C. Presence of a cold agglutinin
A. Howell-Jolly bodies D. Instrument sampling or mixing error
234. Using the percent reticulocyte from B. Basophilic stippling
question 233 and an RBC count of 3.00 X 1012/L C. Pappenheimer bodies 243. What is the principle of automated
(3.00 X 106/|xL), the calculated absolute D. Heinz bodies impedance cell counters?
reticulocyte count reported in SI units is
A. Angle of laser beam scatter by cells
A. 1.8X109/L 239. What is the depth between the counting B. Amplification of an electrical current by cells
B. 18X109/L platform and the coverslip on a hemacytometer? C. Interruption of an electrical current by cells
C. 180X109/L A. 0.01mm
D. Change in optical density of the solution A. Beta-thalassemia major 253. Which of the following statements about
containing cells B. Hereditary spherocytosis microhematocrits is false?
C. Warm autoimmune hemolytic anemia A. Excessive centrifugation causes falsely low
244. A clinically significant difference between D. Burn victims results.
two electronic cell counts is indicated when the B. A tube less than half full causes falsely low
standard deviation is greater than 249. A clotted EDTA tube can be used to perform results.
A. ±1.0 a(n) C. Hemolysis causes falsely low results.
B. ±1.5 A. Erythrocyte sedimentation rate D. Trapped plasma causes falsely high results.
C. ±2.0 B. Solubility test for hemoglobin S
D. ±3.0 C. Hematocrit 254. The erythrocyte sedimentation rate (ESR) is
D. Platelet count influenced by the red cell phenomenon seen in
245. Side angle scatter in a laser-based cell Color Plate 20 •. Which of the following factors
counting system is used to measure 250. The test value range that includes 95% of will neither contribute to this phenomenon nor
A. Cell size the normal population is the affect the ESR?
B. Cytoplasmic granularity A. Reference interval A. Size of the red blood cells
C. Cell number B. Linearity limit B. Shape of the red blood cells
D. Immunologic (antigenic) identification C. Reportable range C. Hemoglobin content of the red blood cells
D. Critical range D. Composition of the plasma
246. A white blood cell count is done on an
automated impedance cell counter from a 251. To establish a standard curve for reading 255. An EDTA blood sample run on an automated
patient with the blood picture seen in Color Plate hemoglobin concentration, impedance cell counter has generated a warning
4 •. The WBC count is most likely A. A commercial control material is used. flag at the upper region of the platelet histogram
A. Falsely increased because of nRBCs B. A wavelength of 640 nm is employed. illustrated below. Which of the following would
B. Falsely increased because of red cell fragments C. Certified standards are used. not be a cause of this warning flag?
C. Falsely decreased because of nRBCs D. A patient blood sample of known hemoglobin A. Nucleated RBCs
D. Accurate; no error with this methodology concentration is used. B. Microcytic RBCs
C. EDTA-dependent platelet agglutinins
247. The hemoglobin A2 quantification using 252. Which of the following is not a source of D. Giant platelets
anion exchange chromatography will be valid in error when measuring hemoglobin by the
A. Hemoglobin C disease cyanmethemoglobin method?
B. Hemoglobin E trait A. Excessive anticoagulant
C. Hemoglobin O trait B. White blood cell count that exceeds linearity
D. Beta-thalassemia minor limits
C. Lipemic plasma
248. Which of the following is not associated D. Scratched or dirty hemoglobin measuring cell
with an increased osmotic fragility and a
decreased surface area-to-volume ratio?
256. To evaluate normal platelet numbers in an B. Warm the specimen to 37°C and rerun. CASE HISTORIES
appropriate area of a blood smear, C. Perform a microhematocrit.
approximately how many platelets should be D. None; the results are reportable. Use the following information to answer
observed per oil immersion field? questions 264-268.
A. 1-4 260. Which of the following tests could be The peripheral blood shown in Color Plate 41 is
B. 4-10 performed on a hemolyzed blood sample? from a 10-month-old Greek boy with the
C. 8-20 A. Hemoglobin only following results on an automated impedance
D. 20-50 B. Hemoglobin and platelet count counter: WBC 35.0 X 109/L (35.0 X 103/(xL); RBC
C. RBC count and hematocrit 2.50 x 1012/L (2.50 x 106/|JL,L); hemoglobin 45
257. Which of the following statements about D. No results would be reportable. g/L (4.5 g/dL); hematocrit 0.16 L7L (16%);
manual reticulocyte counts is false? platelet count 250 X 109/L (250,000/(jLl_);
A. The blood/stain mixture is incubated for 5-10 261. For which of the following procedures reticulocyte count 8.0%; 110 nucleated red blood
minutes. would heparin be a recommended cells/100 WBCs and many targets are seen. Other
B. New methylene blue, a supravital stain, is anticoagulant? laboratory results are as follows: serum iron
used. A. Platelet count elevated; total iron-binding
C. RBC inclusions can result in falsely elevated B. Coagulation tests capacity (TIBC) decreased; serum ferritin
counts. C. Smear-based red cell morphology elevated.
D. An erythrocyte must have at least 4 blue D. Osmotic fragility 264. What is the corrected white blood cell count
particles to be counted as a reticulocyte. expressed in SI units of X109/L?
262. In the platelet count procedure using phase A. 4.6
258. When are automated cell counters required microscopy, B. 12.5
to have a calibration check performed? A. Platelets appear dark against a light C. 16.7
A. At least every 3 months background. D. 18.4
B. After replacement of any major part B. The entire ruled counting surface of the
C. After performing monthly maintenance hemacytometer is used. 265. What would be the appearance of the
D. When the control values are greater than 2 C. Ammonium oxalate will lyse the WBCs. child's red blood cells on a peripheral smear?
standard deviations from the mean D. Platelets should be counted immediately after A. Microcytic, hypochromic
plating the hemacytometer. B. Normocytic, hypochromic
259. A blood sample was run through an 263. What is the quality control term used to C. Normocytic, normochromic
automated cell counter and the following results describe the reproducibility of a test? D. Microcytic, normochromic
were obtained: WBC 6.9 X 109/L (6.9 X 103/(JiL), A. Accuracy
RBC 3.52 X 1012/L (3.52 X 106/|xL), Hgb 120 g/L B. Precision 266. The CBC, serum iron, total iron-binding
(12.0 g/dL), Hct 0.32 L/L (32.0%), MCH 34.1 pg, C. Standard deviation capacity, and serum ferritin levels are most
MCHC 37.5 g/dL. Which of the troubleshooting D. Specificity characteristic of
steps that follows should be performed to obtain A. Beta-thalassemia minor
reportable results? B. Iron-deficiency anemia
A. Perform a saline replacement procedure. C. Alpha-thalassemia minor
D. Beta-thalassemia major D. 15% 273. In the absence of neurological symptoms,
the anemia in this patient is most likely caused by
267. What type(s) of hemoglobin will be 270. The results of the CBC and iron studies in a lack of
detected on this child using hemoglobin this case are most characteristic of A. An enzyme
electrophoresis? A. Beta-thalassemia minor B. Iron
A. A only B. Iron deficiency C. Folic acid
B. A and F C. Sideroblastic anemia D. Intrinsic factor
C. A, increased A2, F D. Anemia of chronic disease
D. F only 274. Which of the following is not a laboratory
271. Which of the following is not associated finding in this general classification of anemia?
268. Why is it difficult to diagnose this disorder with the anemia described in question 270? A. Target cells and schistocytes
in a newborn? A. Chronic gastrointestinal blood loss B. Teardrop cells and macro-ovalocytes
A. The liver is immature. B. Hodgkin lymphoma C. Howell-Jolly bodies and Cabot rings
B. The beta chains are not fully developed at C. Tuberculosis D. Elevated serum LD and iron levels
birth. D. Systemic lupus erythematosus
C. It is similar to hemolytic disease of the Use the following information to answer
newborn (HDN) because of ABO incompatibility. Use the following information to answer questions 275-277.
D. There are normally many erythrocyte questions 272-274. A 45-year-old Scandinavian woman with white
precursors in the peripheral blood. The peripheral blood shown in Color Plate 11 • is hair appears older than her age. She complains
from a 19-year-old female college student who to her physician of weakness, a tingling sensation
Use the following information to answer has been living primarily on tea, beer, and cereal in her lower extremities, and shortness of breath.
questions 269-271. for the past 9 months because she finds dining Her CBC results are as follows: WBC 3.4 x 109/L
A 75-year-old man with rheumatoid arthritis hall food distasteful. She visits student health (3.4 x 103/|xL); RBC 1.90 x 1012/L (1.90 x
complains to his physician of pain and fatigue. His complaining of fatigue. Her CBC results are as 106/|JLL); hemoglobin level 86 g/L (8.6 g/dL);
CBC results are as follows: WBC 6.8 x 109/L (6.8 follows: WBC 2.5 X 109/L (2.5 X 103/|JLL); RBC hematocrit 0.25 L/L (25%); MCV 132 fl_; MCHC
X 103/M,L); RBC 3.49 x 1012/L (3.49 x 106/n,L); 2.10 X 1012/L (2.10 x 106/(xL); hemoglobin 85 34.4 g/dL; platelet count 100 x 109/L
hemoglobin 97 g/L (9.7 g/dL); hematocrit 0.29 g/L (8.5 g/dL); hematocrit 0.24 L/L (24%); platelet (100,000/|jiL). Cabot rings are noted on the
L/L (29%); MCV 83 fl_; MCHC 33.9 g/dL. Other count 110x109/L (110,000/M.L); MCV 114 fL; peripheral smear.
laboratory results are as follows: serum iron and MCHC 35.0 g/dL; reticulocyte count 0.8%.
total iron-binding capacity (TIBC) both 275. The clinical and laboratory findings are most
decreased, serum ferritin slightly elevated 272. What test(s) should be done first to consistent with
determine a diagnosis in this patient? A. Liver disease
269. If the serum iron is 22 jJig/dL and the TIBC is A. Vitamin B12 and Mate levels B. Pernicious anemia
150 |xg/dL, what is the percent transferrin? B. Iron studies C. Folic acid deficiency
A. 7% C. Bone marrow examination D. Aplastic anemia
B. 10% D. Osmotic fragility
C. 12%
276. Which of the following is not associated 279. The defect in this disorder is caused by an C. Decreased serum ferritin
with this disorder? A. Amino acid substitution D. Increased bilirubin
A. Alcoholism B. Intrinsic red blood cell membrane defect
B. Antibodies to intrinsic factor or parietal cells C. Enzyme deficiency in the hexose 283. What is the toddler's absolute reticulocyte
C. Diphyllobothrium latum infection monophosphate shunt count?
D. Achlorhydria D. Enzyme deficiency in the Embden-Meyerhof A. 0.05X109/L
pathway B. 0.5X109/L
277. Which of the following statements about C. 5X109/L
megaloblastic anemia is true? 280. Inclusions that form when the patient is D. 50X109/L
A. Oral folate therapy reverses the neurologic oxidatively challenged are composed of
symptoms of PA. A. RNA Use the following information to answer
B. Intramuscular injections of vitamin B12 will B. Denatured hemoglobin questions 284-288.
reverse the neurologic symptoms of PA. C. DNA An 8-year-old girl is seen by the family physician.
C. Methotrexate (chemotherapeutic agent) is a D. Iron On physical examination, the physician notes
vitamin B^ antagonist. fever, sore throat, bruising, petechiae, and pallor.
D. Folate deficiency takes years to develop Use the following information to answer A CBC is drawn and the results are as follows:
questions 281-283. WBC 110x109/L (110X103/M-L); RBC 1.70 x
Use the following information to answer A 15-month-old malnourished child is brought to 1012/L (1.70 x 106/|xL); hemoglobin 55 g/L (5.5
questions 278-280. the clinic for a routine examination. Her CBC g/dL); hematocrit 0.16 L/L (16%); differential
A 32-year-old African-American traveling to results are as follows: WBC 9.5 x 109/L (9.5 x count shows 93% blasts and 7% lymphocytes. A
Africa on business had been healthy until he 103/(xL); RBC 2.70 X 1012/L (2.70 X 10%iL); bone marrow examination is performed and
began taking primaquine for prevention of hemoglobin 67 g/L (6.7 g/dL); hematocrit 0.25 reveals 85% blasts. All of the blasts are small with
malaria. He went to his physician because he felt L/L (25%); MCV 73.5 fl_; MCHC 26.8 g/dL; no variation in their appearance.
faint and his urine was black. His CBC results are reticulocyte 0.2%; ROW 19%. Abnormal RBC
as follows: WBC 6.5 X 109/L (6.5 X 103/^L); RBC morphology present included pencil forms and 284. Which of the following would you expect to
1.67 X 1012/L (1.67 x 1 O%L|_); hemoglobin level target cells. most accurately reflect the child's platelet count?
50 g/L (5.0 g/dL); hematocrit 0.15 L7L (15%); A. 10X109/L
MCV 89.8fL; MCHC 33.3 g/dL; platelet count 175 281. What is this toddler's most probable B. 100X109/L
x 109/L (175,000/|jiL); reticulocyte25.0%. diagnosis? C. 200X109/L
A. Folic acid deficiency D. 400X109/L
278. The most likely cause of this hemolytic B. Hereditary spherocytosis
episode is C. Iron deficiency 285. What is this child's most probable
A. G6PD deficiency D. Erythroblastosis fetalis diagnosis?
B. Hereditary spherocytosis A. Acute lymphoblastic leukemia
C. Sickle cell disease 282. The earliest indicator of this disease state is B. Acute myelogenous leukemia
D. Pyruvate kinase deficiency A. Decreased folic acid C. Hairy cell leukemia
B. Decreased serum iron D. Myelodysplastic syndrome
 blasts were myeloperoxidase and specific Use the following information to answer
286. Which of the following cytochemical stains esterase positive; nonspecific esterase and PAS questions 293-296.
would most likely be positive in the blast cells of negative. An 83-year-old woman is seen in the emergency
this patient? department complaining of fatigue and recent
A. Myeloperoxidase 289. What is this patient's most likely diagnosis? weight loss. Her CBC results are as follows: WBC
B. Leukocyte alkaline phosphatase A. Acute myelogenous leukemia without 2.6 X 109/L (2.6 X 103/|xL); RBC 2.79 X 1012/L
C. Periodic acid-Schiff maturation (FAB type Ml) (2.79 x 106/|jiL); hemoglobin 92 g/L (9.2 g/dL);
D. Nonspecific esterase B. Acute myelogenous leukemia with maturation hematocrit 0.28 L/L (28%); MCV 100.0 fl_; ROW
(FAB type M2) 23.5%; platelet count 42 x 109/L (42,000/|xl_);
287. Terminal deoxyribonucleotidyl transferase C. Acute monocytic leukemia (FAB type M5) differential count shows 42% segmented
(TdT) is present in D. Myelodysplastic syndrome neutrophils, 45% band neutrophils, 3%
A. Precursor B and precursor T lymphoid cells lymphocytes, 3% metamyelocytes, 4%
B. Mature B and T lymphocytes 290. Cytogenetic studies would most likely show myelocytes, 3% blasts, and 4 nRBC/100 WBC.
C. Precursor B cells and mature B lymphocytes which of the following chromosome Morphologic changes noted on the differential
D. Precursor T cells and mature T lymphocytes abnormalities? smear include poor granulation and
288. The presence of CD2, CD5, CD7 and the A. t(8;21) hyposegmentation of the neutrophils, giant
absence of CD10 (CALLA) are associated with B. t(8;14) platelets that display poor granulation, oval
A. B lymphocytes C. t(9;22) macrocytes, basophilic stippling, Cabot rings,
B. T lymphocytes D. t(15;17) Pappenheimer bodies, and Howell-Jolly bodies.
C. Myeloid cells Three micromegakaryocytes are seen per 100
D. Monocytic cells 291. Using World Health Organization (WHO) WBCs. Serum B12 and folate levels are normal.
criteria for the diagnosis of acute leukemia, the
Use the following information to answer percentage of bone marrow blasts must be at 293. The peripheral blood findings are most
questions 289-292. least consistent with
The peripheral blood smear in Color Plate 1?• A. 5 A. Myelodysplastic syndrome
and the Sudan black B stain in Color Plate 19 • B. 20 B. Degenerative left shift
are from a 90-year-old man complaining of C. 30 C. Megaloblastic anemia
fatigue and nosebleeds. The physician noted the D. 50 D. Chronic myelogenous leukemia
patient was febrile and had petechiae. CBC
results were as follows: WBC 20.0 x 109/L (20.0 x 292. Which of the following is not considered an 294. The expected bone marrow findings in this
103/(jLl_); RBC 2.58 x 1012/L (2.58 x 106/|xl_); underlying condition that predisposes a patient disorder using WHO criteria are
hemoglobin 77 g/L (7.7 g/dL); hematocrit 0.24 to acute leukemia? A. Hypocellular; blasts > 20%
L7L (24%); platelet count 32 x 109/L A. Viral infections B. Hypocellular; blasts <20%
(32,000/(jLl_); differential count shows 75% B. Bacterial infections C. Hypercellular; blasts > 20%
blasts, 20% lymphocytes, and 5% segmented C. Chronic bone marrow dysfunction D. Hypercellular; blasts <20%
neutrophils. A bone marrow examination D. Congenital chromosome abnormalities
revealed 80% cellularity with 80% blasts. The
295. If the bone marrow in this patient had 18% B. Chronic myelogenous leukemia
blasts, the most likely disorder would be C. Acute myelogenous leukemia
A. Chronic myelomonocytic leukemia (CMML) D. Regenerative left shift
B. Chronic myelogenous leukemia (CML)
C. Refractory anemia with ringed sideroblasts 298. Which of the following would yield the most
(RARS) diagnostic information for this patient?
D. Refractory anemia with excess blasts (RAEB) A. Sudan black B (SBB)
B. Periodic acid-Schiff (PAS)
296. Which of the following is a false statement C. Tartrate-resistant acid phosphatase (TRAP)
about myelodysplastic syndromes? D. Leukocyte alkaline phosphatase (LAP)
A. MDS is "preleukemic" and frequently
terminates in acute leukemia. 299. Which of the following myeloproliferative
B. Treatment for MDS is only supportive and not disorders is characterized by the presence of a
a cure. t(9;22) chromosome abnormality and the
C. Median survival for all types of MDS is 5 years. BCR/ABL oncogene?
D. The lower the blast percent, the longer is the A. Polycythemia vera
survival rate. B. Essential thrombocythemia
C. Chronic myelogenous leukemia
Use the following information to answer D. Chronic idiopathic myelofibrosis
questions 297-300.
A 53-year-old man reported to the laboratory for 300. How does the presence of this chromosome
routine blood work as part of a yearly physical. abnormality affect the prognosis?
He had been feeling tired for the last few months. A. It is not a prognostic indicator.
Physical examination revealed splenomegaly. His B. The prognosis is better when the abnormality
CBC results are as follows: WBC 80.0 x 109/L is present.
(80.0 X 103/(juL); RBC 4.10x1012/L (4.10 X C. The prognosis is better when the abnormality
10%,L); hemoglobin 123 g/L (12.3 g/dL); is not present.
hematocrit 0.37 L7L (37.0%); platelet count 650 D. Progression to acute lymphoblastic leukemia
x 109/L (650,000/jjiL); differential count shows occurs more often when the abnormality is
40% polymorphonuclear neutrophils, 18% present.
bands, 5% metamyelocytes, 7% myelocyte, 28%
lymphocytes, and 2% monocytes. No RBC or
WBC morphologic abnormalities are seen.

297. The peripheral blood findings are most

consistent with a diagnosis of
A. Neutrophilic leukemoid reaction
CIULLA HEMOSTASIS (HEMA 2) B. Changes in platelet shape B. Change in optical density: As platelets
C. Release of endogenous ADP aggregate, the optical density of the platelet-rich
PRINCIPLES OF COAGULATION D. Release of platelet factor 3 plasma decreases.
1. The hemorrhagic problems associated with C. Electrical impedance: Platelet aggregates are
scurvy are due to a deficiency of, which is a 6. A platelet aggregation agent that counted as they pass through an aperture,
cofactor required for collagen synthesis. characteristically yields a biphasic curve when temporarily interrupting the flow of current
A. Vitamin C used in optimal concentration is between two electrodes.
B. Prothrombin A. Arachidonic acid D. Pulse editing: Editing electronically generated
C. Vitamin K B. Collagen pulses can differentiate the number of free
D. Protein C C. Epinephrine platelets versus platelet aggregates.
D. Ristocetin
2. The number of platelets an average 9. Of the following therapeutic agents, those
megakaryocyte generates is approximately 7. The platelet aggregation pattern drawn below considered to be antiplatelet medications are
A. 25-50 is characteristic of the aggregating agent A. Aspirin and Plavix®
B. 50-200 A. ADP B. Coumadin® and heparin
C. 200-500 B. Collagen C. Heparin and protamine sulfate
D. 2000-4000 C. Ristocetin D. Tissue plasminogen activator and
D. Thrombin streptokinase
3. Which of the following is not a cause of
thrombocytopenia? 10. A potent inhibitor of platelet aggregation
A. Splenomegaly released by endothelial cells is
B. Chemotherapy A. Epinephrine
C. Increased thrombopoietin B. Prostacyclin
D. Aplastic anemia C. Ristocetin
D. Thromboxane A2
4. Platelets interacting with and binding to other
platelets is referred to as 11. The reference value for mean platelet volume
A. Adhesion (MPV) is approximately
B. Aggregation 8. The operating principle of a platelet A. 2-4 fL
C. Release aggregometer is best described as B. 5-7 fL
D. Retraction A. Aggregation on a foreign surface: Platelet C. 8-10 fL
aggregation is directly proportional to the D. 11-14 fL
5. In platelet aggregation studies, certain difference in platelet counts performed before
aggregating agents induce a biphasic aggregation and after platelet-rich plasma is passed through 12. The platelet parameter PDW refers to the
curve. This second phase of aggregation is a column of glass beads. A. Average platelet volume
directly related to B. Cell weight versus density
A. Formation of fibrin C. Capacity to adhere to foreign surfaces
D. Variation in platelet cell size A. 0-10 fL C. Factor IX and factor X
B. 2-20 fL D. von Willebrand factor and factor VIII
13. A normal histogram showing platelet size C. 15-40fL
distribution is best described as D. 35-90 fL 23. Prekallikrein deficiency is associated with
A. Bimodal, nonskewed peaks A. Prolonged aPTT that does not correct with a
B. Left-skewed single peak 18. In storage pool disease, platelets are mixing study
C. Right-skewed single peak primarily deficient in B. Autosomal dominant inheritance
D. Single peak, Gaussian distribution A. ADP C. Increased risk of thrombosis
B. Platelet factor 3 D. Delayed bleeding at the incision site following
14. Which of the following is not a normal C. Thrombasthenin surgery
maturation stage for platelets? D. Thromboxane A2
A. Megakaryoblast 24. Which of the following will not cause the
B. Promegakaryocyte 19. The anticoagulant required for routine thrombin time to be prolonged?
C. Micromegakaryocyte coagulation testing is A. Fibrin degradation products
D. Megakaryocyte A. Sodium heparin B. Heparin
B. Sodium citrate C. Factor I deficiency
15. The recommended type of microscopy for C. Acid citrate dextrose D. Factor II deficiency
the performance of manual platelet counts is D. Sodium fluoride
A. Electron 25. The expected screening test results for a
B. Dark field 20. Which of the following is not synthesized in patient with a fibrin stabilizing factor deficiency
C. Light the liver? are
D. Phase contrast A. Factor VIII A. Prolonged prothrombin time
B. Plasminogen B. Prolonged activated partial thromboplastin
16. Twenty microliters of blood are diluted in C. Protein C time
1.98 mL of diluent. This dilution is plated on both D. von Willebrand factor C. Prolonged prothrombin time and activated
sides of a Neubauer-ruled counting chamber. A partial thromboplastin time
total of 356 cells is seen when both large center 21. When thrombin binds to thrombomodulin on D. Normal prothrombin time and activated
squares are counted. The platelet count the endothelial cell surface, thrombin can partial thromboplastin time
expressed in SI units is A. Activate the protein C pathway
A. 178xl09/L B. Activate factor V and factor VIII 26. A patient on therapeutic warfarin will most
B. 178xl03/|xL C. Convert fibrinogen to fibrin likely have a(n)
C. 356xl09/L D. Stimulate platelet aggregation A. Normal PT/INR, increased aPTT, prolonged
D. 712xl09/L bleeding time, low platelet count
22. The coagulation factors having a sexlinked B. Increased PT/INR, increased aPTT, normal
17. The size threshold range used by electrical recessive inheritance pattern are bleeding time, normal platelet count
impedance methods to count particles as A. Factor V and factor VIII C. Normal PT/INR, normal aPTT, normal bleeding
platelets is B. Factor VIII and factor IX time, normal platelet count
D. Increased PT/INR, normal aPTT, prolonged B. Plasmin 36. Measurement of the time required for fibrin
bleeding time, low platelet count C. Prothrombin formation when thrombin is added to plasma
D. Thrombin evaluates the
27. Which of the following complexes is not A. Fibrinogen concentration
needed for blood coagulation to occur? 32. The activity of the lupus anticoagulant and B. Prothrombin concentration
A. Vila, tissue factor, Ca2+ anticardiolipin antibodies appears to be directed C. Extrinsic clotting system
B. IXa, VIII, Ca2+, PF3 against D. Intrinsic clotting system
C. Xa, V, Ca2+, PF3 A. Factor V
D. Xlla, kallikrein, HMWK B. FactorVIII 37. A fibrinogen assay is performed on the
C. Factor IX fibrometer using the standard 1:10 dilution with
28. von Willebrand factor is a D. Phospholipid Owren's buffer. The seconds obtained do not
A. Phospholipid required for multiple reactions in read on the standard curve. An alternate 1:20
the coagulation sequence 33. Heparin inhibits clotting by dilution is performed and is 400 mg/dL when
B. Plasma protein that binds platelets to exposed A. Chelating calcium ions read off the curve. The concentration of
subendothelial collagen B. Preventing activation of prothrombin fibrinogen to be reported in mg/dL is
C. Plasma protein with procoagulant activity in C. Causing liver synthesis of non-functional A. 160 mg/dL
the intrinsic coagulation system factors B. 200 mg/dL
D. Platelet membrane glycoprotein that attaches D. Enhancing the action of antithrombin C. 400 mg/dL
the platelet to the injured vessel wall D. 800 mg/dL
34. The main regulatory protein of secondary
29. Fibrin strands are cross-linked and the fibrin hemostasis is 38. Which of the following is not true of the
clot is stabilized by the activity of A. Antithrombin international normalized ratio (INR)?
A. a2-Antiplasmin B. Protein C A. INR is dependent on reagents and
B. Factor XHIa C. oc2-Antiplasmin instrumentation used.
C. Plasmin D. Tissue plasminogen activator B. INR is calculated using the PT ratio taken to the
D. Thrombin power of the ISI value.
35. Why is the activated partial thromboplastin C. The World Health Organization recommends
30. Which of the following does not contribute to time (aPTT) not the procedure of choice for reporting the INR on patients on stable oral
the activation of the fibrinolytic system? detecting a platelet factor 3 (PF3) deficiency? anticoagulant therapy.
A. Xlla A. Platelet-rich plasma is used for this test. D. A therapeutic INR for a patient on
B. XIa B. The reagent contains a phospholipid Coumadin® is between 2.0 and 3.0, but may be
C. Kallikrein substitute for PF3. higher depending on the cause of the patient's
D. Tissue plasminogen activator C. PF3 is unstable in the reagent used for this underlying disease state.
test.
31. Which of the following enzymatically D. PF3 does not function in the system being 39. A prolonged aPTT result is obtained on a
degrades the stabilized fibrin clot? tested. patient diagnosed with acute disseminated
A. Plasminogen intravascular coagulation (DIG). The patient has
not yet been treated for this disorder. The most 43. A clot retraction defect is most likely due to A. Fibrinogen and prothrombin
likely cause of the prolonged aPTT is A. Lack of platelet receptor glycoprotein Ib B. Stable and labile factors
A. In addition to DIG, the patient is deficient in a B. Lack of platelet receptor glycoprotein Ilb/IIIa C. Protein C and protein S
factor required for the extrinsic pathway. C. Insufficient ADP in dense bodies D. Fletcher and Fitzgerald factors
B. DIG is characterized by synthesis of less stable D. Absence of von Willebrand factor
coagulation factors, which deteriorate rapidly in 49. A 25-year-old male presents to his physician
the circulation. 44. Thrombocytosis is a characteristic of complaining of leg pain. The physician diagnoses
C. Systemic activation of the coagulation system A. Disseminated intravascular coagulation a deep vein thrombosis and wants to determine
depletes some factors more rapidly than the liver B. Splenomegaly the cause of the thrombotic episode. Which of
can synthesize them. C. Polycythemia vera the following conditions would not be associated
D. The patient has been misdiagnosed; a D. Idiopathic thrombocytopenic purpura with such a thrombotic episode?
prolonged aPTT indicates that the problem is A. Factor V Leiden and Prothrombin 20210
deficient, not excessive, coagulation. 45. In which of the following functions are the mutations
products released by vascular endothelial cells B. Hypofibrinogenemia and
40. Which of the following test results is not not involved? hyperhomocysteinemia
characteristic of DIG? A. Inhibition of platelet aggregation C. Lupus anticoagulant and anticardiolipin
A. Decreased fibrinogen concentration B. Activation of the fibrinolytic system antibodies
B. Positive test for degradation products C. Conversion of thrombin from a procoagulant D. Antithrombin and protein C deficiencies
C. Decreased platelet count to an anticoagulant
D. Increased antithrombin D. Cross-linkage of fibrin monomers 50. An 85-year-old male with slurred speech and
paralysis on the right side of the body is seen in
41. The principle of methods depends on 46. If a physician suspects a qualitative platelet the emergency department. A stat D-dimer is
cleavage of synthetic substrates by an active defect, the most useful test to order is the ordered and is very high. The physician suspects
serine protease. A. Platelet count a thromboembolic event based on the D-dimer,
A. Chromogenic B. Prothrombin time and needs to institute clot-dissolving therapy
B. Photo-optical C. 5.OM urea solubility test immediately. The most likely diagnosis and
C. Mechanical D. Bleeding time appropriate therapy for the patient is
D. Immunodiffusion A. Myocardial infarction; treat with aspirin
47. The coagulation factors referred to as B. Pulmonary embolism; treat with warfarin
42. Epsilon aminocaproic acid is the treatment of "vitamin K-dependent" are C. Deep vein thrombosis; treat with heparin
choice for A. I, V, VIII, XIII D. Stroke; treat with tissue plasminogen activator
A. von Willebrand disease B. II, V, IX, XII
B. Hemophilia A C. II, VII, IX, X 51. Reversal of a heparin overdose can be
C. DIG with secondary fibrinolysis D. XI, XII, Fletcher, Fitzgerald achieved by administration of
D. Primary fibrinogenolysis A. Vitamin K
48. A patient on warfarin therapy will be deficient B. Protamine sulfate
in a functional amount of C. Antithrombin
D. Warfarin 56. A microtainer EDTA sample obtained during a CBC with platelet count. An automated platelet
fingerstick puncture is run on an automated cell count performed on the specimen is 57 x 109/L.
52. Which of the following best describes protein counter, yielding a platelet count of 178 x 109/L. In the monolayer area of the peripheral blood
C? In the erythrocyte monolayer of the stained smear there are approximately 12 platelets per
A. Vitamin K-dependent inhibitor to clotting peripheral blood smear, an average of 9 platelets oil immersion field, many of which are encircling
B. Activator of factors V and VIILC per field is seen under lOOOx magnification. neutrophils. Controls are in range. Based on this
C. Inhibitor of fibrinolysis Based on these data, you should information, the best course of action is
D. Synthesized by endothelial cells A. Report the results because the platelet count A. Report all the results because the instrument
and platelet estimate correlate. is functioning properly.
53. The prothrombin time will detect deficiencies B. Recollect a specimen for a repeat platelet B. Alert the physician immediately so
in the pathway(s) when calcium and a tissue count because the platelet count and estimate cancellation of surgery can be considered.
factor source such as rabbit brain are added to do not correlate. C. Thoroughly mix specimen and repeat platelet
plasma. C. Examine the periphery of the blood smear for count; if results remain the same, report all
A. Extrinsic clumping because the platelet count and results and indicate that platelet count has been
B. Extrinsic and common estimate do not correlate. confirmed by repeat testing.
C. Intrinsic D. Rerun the platelet count on the available D. Have the specimen redrawn using 3.2%
D. Intrinsic and common specimen to confirm the results. sodium citrate as the anticoagulant.

54. A 65-year-old patient in the emergency 57. Blood for an aPTT was collected from a 5- 59. Phlebotomist Forgetful Frank collected a tube
department has a normal D-dimer and an year-old boy. During the venipuncture, he had to of blood for an aPTT on John Smith at 10:00 A.M.
elevated FDP result. These results are consistent be restrained by several people and still managed The blood was collected in a sodium citrate tube.
with the presence of degradation products of to be a moving target. The result of the child's At 4:30 P.M., Frank was getting ready to leave for
A. Non-cross-linked fibrin aPTT was 18.0 sec (reference range 22.0-38.0 the day when he discovered Mr. Smith's blood
B. Cross-linked fibrin sec). The aPTT controls were in range. Which of specimen on his blood collection tray. So before
C. Fibrinogen the following interpretations would apply to the leaving, Frank delivered the tube of blood to the
D. Plasmin Specimen Acceptability aPTT result? laboratory for testing. Which of the following
A. aPTT is abnormal because of a hereditary best describes the expected results?
55. A specimen is received for a prothrombin factor deficiency. A. Sodium citrate is a preservative as well as an
time and activated partial thromboplastin time. B. aPTT is invalid because of contamination with anticoagulant, so the aPTT result should be
The 5 mL tube has 2.5 mL of blood in it. Expected tissue factor. accurate.
test results are C. Tube is probably not full, resulting in a falsely B. An aPTT collected in sodium citrate will give
A. PT and aPTT both falsely short short time. falsely long results because some factors are
B. PT and aPTT both falsely long D. Result is within reference range for a patient unstable in this anticoagulant.
C. PT and aPTT both unaffected of this age. C. A falsely long aPTT is expected because some
D. PT unaffected, aPTT falsely short factors deteriorate rapidly at room temperature.
58. Laboratory tests requested on a patient
scheduled for early morning surgery include a
D. Exposure of the plasma to erythrocytes for D. VIII, IX, XI, XII
several hours has probably activated the factors,
so the aPTT will be falsely short. CASE STUDIES
62. A 30-year-old female is admitted to the
60. An aPTT and PT are requested on a patient hospital with neurological symptoms. The
scheduled for emergency surgery. On an optical following results are obtained:
density clot detection system, normal and
abnormal controls for both tests are within
range, but the patient's results exceed the upper
limit of linearity. The patient's aPTT and PT have These results are consistent with
been performed in duplicate, but there still is A. Christmas disease
sufficient plasma, which is grossly lipemic, to B. Hemophilia A
repeat the tests. What is the best course of C. Glanzmann thrombasthenia
action to follow? The most likely diagnosis for the patient is D. von Willebrand disease
A. Report the results immediately by phone, A. Thrombotic thrombocytopenic purpura
emphasizing that the tests were run in duplicate B. Idiopathic thrombocytopenic purpura 65. Laboratory results on a 6-year-old female
and the controls are within range. C. Hemolytic uremic syndrome with petechiae and severe epistaxis are as
B. Request a new specimen and repeat the aPTT D. von Willebrand disease follows:
and PT using freshly diluted controls.
C. Repeat the aPTT and PT on an instrument that 63. A 4-year-old child is seen in the emergency
detects clot formation electromechanically. department with petechiae and a platelet count
D. Inform the physician that accurate results are of 15 x 109/L. She has no previous history of
impossible. bleeding problems. Three weeks earlier she had
chicken pox. The physician advises the parents to
61. A sodium citrate tube is received in the keep the child off the playground to avoid injury,
laboratory for PT and aPTT testing. and says the child will recover within 2-4 weeks
Results are as follows: with no further treatment. What condition does
this child most likely have?
A. Essential thrombocythemia
B. Idiopathic thrombocytopenic purpura These results are consistent with
C. Thrombotic thrombocytopenic purpura A. Bernard-Soulier syndrome
On examination, a large clot is discovered. The D. Glanzmann thrombasthenia B. von Willebrand disease
abnormal test results are due to deficiencies of C. Glanzmann thrombasthenia
factors 64. Laboratory results on a 16-year-old female D. Ehlers-Danlos syndrome
A. I, V, VIII, IX with frequent nosebleeds and severe
B. I, II, V, VIII, XIII menorrhagia are as follows: 66. A clot retraction defect is suspected in a
C. II, VII, IX, X newborn male experiencing severe bleeding
following circumcision. The following results are 68. An 80-year-old man suffered a heart attack 1 tube containing 3.2% sodium citrate. The
obtained: month ago, and after the hospital stay was standard collection procedure was followed, and
discharged with instructions to follow an all tests were performed within the appropriate
outpatient treatment plan. He arrives at the time limits. Based on this information, the
cardiology clinic today for lab work to monitor statement that best explains the prolonged
the treatment plan. coagulation test results is
The following results are obtained: A. Coagulation reactions require platelet factor 3;
availability of this component is insufficient
when the platelet count is below 100xl09/L.
B. The ratio of anticoagulant to blood is critical;
the volume of anticoagulant must be decreased
when the Hct is greater than 55%.
These results are characteristic of This patient is most likely on a
C. The PT and aPTT evaluate the extrinsic and
A. von Willebrand disease A. Nontherapeutic dose of unfractionated
intrinsic pathways, respectively; prolongation of
B. Glanzmann thrombasthenia heparin
both tests indicates a deficiency of a factor
C. Storage pool disease B. Nontherapeutic dose of coumarin
common to both systems.
D. Christmas disease C. Nontherapeutic dose of both unfractionated
D. Coagulation reactions are inhibited by a
heparin and coumarin
product released by leukocytes; this inhibitory
67. Results on a 35-year-old male presenting with D. Fibrinolytic agent such as tissue plasminogen
activity becomes significant when the leukocyte
sudden severe hemorrhagic problems are as activator
count is greater than 20.0 x 109/L.
follows:
69. The following results are obtained on a 60-
70. The following results are obtained on a 3-
year-old male patient:
year-old boy with sudden severe hemorrhagic
problems:

These clinical manifestations and laboratory

results are consistent with
A. Lupus anticoagulant
B. von Willebrand disease
C. Hemophilia A The WBC, RBC, Hgb, Hct, and Pit were performed These clinical manifestations and laboratory
D. Factor VIII inhibitor on blood collected in an evacuated tube results are consistent with
containing EDTA. The PT and aPTT were A. Aspirin therapy
performed on blood collected in an evacuated B. von Willebrand disease
C. Hemophilia A B. DIG with secondary fibrinolysis
D. Heparin therapy C. Factor II deficiency
D. Coumadin® therapy
71. Screening tests for a 46-year-old male patient
admitted for minor surgery follow: 74. A patient in the hospital for an acute
myocardial infarction is placed on standard
unfractionated heparin therapy and aspirin.
Laboratory results are performed before
instituting therapy and then daily as shown:

These laboratory results are consistent with

The patient has no clinical manifestations of a
A. Primary fibrinogenolysis
bleeding problem and has no personal or family
B. DIG with secondary fibrinolysis
history of bleeding problems, even following
C. Factor II deficiency
dental extraction. Several family members have The most likely complication by Day 3 is
D. Heparin therapy
been treated for deep vein thrombosis. Based on A. Disseminated intravascular coagulation
these laboratory results and the clinical history, B. Primary fibrinogenolysis
73. A 57-year-old man with prostate cancer is
the most likely cause of the prolonged aPTT is C. Aspirin-induced thrombocytopenia
admitted to the intensive care unit with severe
A. Heparin present in the sample D. Heparin-induced thrombocytopenia
bleeding problems. The following laboratory
B. Factor VIII deficiency
results are obtained:
C. Factor XII deficiency 75. A 24-year-old female with painful swelling in
D. Factor XIII deficiency her left leg is seen by her physician, who orders
laboratory testing for PT and aPTT. The PT is
72. A 25-year-old obstetrical patient at 35 weeks normal. The aPTT is prolonged, but shortens with
gestation is admitted through the emergency a 10-minute incubation of patient plasma with
room. She has bleeding in the genitourinary partial thromboplastin reagent that uses kaolin
tract, and there are visible petechiae and as the activator. A 1:1 aPTT mixing study corrects
ecchymoses. The following laboratory results are to normal. The most likely diagnosis is
obtained: A. Factor II deficiency
B. FactorVIII inhibitor
C. Factor XIII deficiency
D. Prekallikrein deficiency

These laboratory results are consistent with

A. Primary fibrinogenolysis
CIULLA IMMUNOLOGY & SEROLOGY antibody-coated antigen to be phagocytizeed 10. A young woman shows increased
what part of the antibody molecule fits into a susceptibility to pyogenic infections. Upon assay
1. Color Plate 21B depicts a monomeric receptor on the phagocytic cell? she shows a low level of C3. Which of the
immunoglobulin molecule. The portion of the A. Fc region following statements is probably true?
molecule indicated by the dotted red circle and B. Fab region A. She has an autoimmune disease with
the red arrow is called the C. Hinge region continual antigen-antibody activity causing
A. Fab fragment D. Variable region consumption of C3.
B. Fc fragment B. She has DiGeorge syndrome.
C. Heavy chain 6. Cell-mediated immunity is primarily mediated C. She has decreased production of C3.
D. Hinge region by D. She may produce an inactive form of C2 a
A. B cells precursor of C3.
2. A hapten is B. T helper cells
A. Half of an immunoglobulin molecule C. Plasma cells 11. What is the predominant type of antibody
B. A earner molecule for an antigen that is not D. Dendritic cells found in the serum of neonates born after full-
antigenic alone term gestation?
C. An immunoglobulin functional only in the 7. The HLA complex is located primarily on A. Infant IgA
presence of complement A. Chromosomes B. Infant IgG
D. A determinant capable of stimulating an B. Chromosome 6 C. Infant IgM
immune response only when bound to a carrier C. Chromosome 9 D. Maternal IgG
D. Chromosome 17
3. Which of the following is characteristic of B 12. An important part of the nonspecific immune
cells? 8. HLA antigens are found on response is(are)
A. Phagocytic A. All nucleated cells A. B cells
B. Participate in antibody-dependent cellular B. Red blood cells only B. Basophils
cytotoxicity (ADCC) reactions C. Solid tissue only C. Complement cascade
C. Contain surface immunoglobulins D. White blood cells only D. Cytotoxic T lymphocytes
D. Secrete the C5 component of complement
9. Which of the following is more likely to be 13. The major class of immunoglobulin found in
4. A lymphokine is diagnostic of an acute infection? adult human serum is
A. A soluble mediator produced by granulocytes A. A total acute antibody liter of 2 followed by a A. IgA
and affecting lymphocytes convalescent titer of 16 B. IgE
B. A soluble mediator produced by lymphocytes B. A total acute antibody titer of 80 followed by a C. IgG
C. A soluble mediator produced by plasma cells convalescent titer of 40 D. IgM
D. An antibody that reacts with lymphocytes C. A total antibody titer of 80
D. An IgG antibody titer of 80 14. Which class of immunoglobulin possesses
5. Monocytes and macrophages play a major role delta heavy chains?
in the mononuclear phagocytic system. For an A. IgA
B. IgD A. Agglutinates by binding to antibodycoated may recognizee antigens in the recipient and
C. IgE latex beads respond to those antigens. This phenomenon is
D. IgG B. Binds to enzeyme-labeled antibody an example of
C. Competes with enzeyme-labeled antigen for A. Acute rejection
15. Which class of immunoglobulin possesses 10 binding to a specific antibody B. Chronic rejection
antigenic binding sites? D. Forms antibody-antigen complex and C. Graft versus host disease
A. IgA precipitates D. Hyperacute rejection
B. IgD
C. IgG 20. Severe combined immunodeficiency (SCID) is 24. Multiple myeloma is a
D. IgM an A. Lymphoproliferative disease of T cells
A. Immunodeficiency with decreased B cells and B. Cancer of plasma cells characterizeed by
16. Color Plate 22 • represents a dimeric IgA neutrophils increased antibody concentration
molecule. The structure printed in red and B. Immunodeficiency with lymphocytopenia and C. Lymphoproliferative disease resulting in a
indicated by the red arrow is called the eosinophilia decrease in antibody production
A. J-piece C. Immunodeficiency with decreased or D. Cancer of monocytes characterizeed by
B. Hinge region dysfunctional T and B cells increased kappa and lambda chain synthesis
C. Heavy chain D. Immunodeficiency with decreased
D. Light chain lymphocytes and decreased complement 25. Which one of the following describes a direct
concentration immunofluorescence assay?
17. Which class of immunoglobulin binds to A. Conjugated reagent antigen reacts with
basophils and mast cells to mediate immediate 21. An example of immune injury due to the antibodies to form antigen-antibody complexes
hypersensitivity reactions? deposition of antigen-antibody complexes is B. Antigens react with unlabelled antibody
A. IgA A. Acute glomerulonephritis forming antigen-antibody complexes that attach
B. IgD B. Bee-sting allergy to labelled antibodies
C. IgE C. Contact dermatitis C. A dye is attached to a molecule and it reacts
D. IgG D. Penicillin allergy with an immune complex to produce a color
D. Conjugated reagent antibody reacts with
18. Type I hypersensitivity is 22. The serologically detectable antibody antigen to form antigen-antibody complexes
A. Associated with complementmediated cell produced in rheumatoid arthritis (RA) is primarily
lysis of the class 26. In individuals allergic to pollen
B. Due to immune complex deposition A. IgA hyposensitizeation protocols may be initiated.
C. Mediated by activated macrophages B. IgE These individuals receive injections of
D. An immediate allergic reaction C. IgG A. Allergen
D. IgM B. Pooled human antisera
19. When performing the enzeyme-multiplied C. Monoclonal antibody directed against human
immunoassay technique (EMIT) how is the 23. In bone marrow transplantation T cells
ligand in the patient's serum detected? immunocompetent cells in the donor marrow
D. Monoclonal antibody directed against human B. Anti-DNaseB 36. The strength with which a multivalent
B cells C. Anti-beta-toxin antibody binds a multivalent antigen is termed
D. C-reactive protein the
27. After exposure to antigen the first antibodies A. Affinity
that can be detected belong to the class 32. A molecule found in human serum B. Avidity
A. IgA sometimes used as a tumor marker is C. Reactivity
B. IgE A. a-Fetoprotein D. Valence
C. IgG B. HBsAg
D. IgM C. Biotin 37. How does the secondary humoral immune
D. GDI response differ from the primary response?
28. Corneal tissue may be transplanted A. The lag phase (the time between exposure to
successfully from one patient to another because 33. Which cell is the principal source of immunogen and production of antibody) is
A. The cornea is nonantigenic interleukin 2? longer in the secondary immune response.
B. Cornea! antigens do not activate T cells A. Bcell B. IgM is the predominant antibody class
C. Anticorneal antibodies are easily suppressed B. Tcell produced in the secondary immune response.
D. The cornea occupies a privileged site not C. Monocyte C. The antibody levels produced are higher in the
usually seen by the immune system D. Plasma cell secondary immune response.
D. Cytotoxic T lymphocytes play an important
29. A kidney transplant from one identical twin 34. Diagnostic reagents useful for detecting role in the secondary response.
to another is an example of a(n) antigen by the coagglutination reaction may be
A. Allograft prepared by binding antibody to killed 38. After activation of the complement system
B. Autograft staphylococcal cells via the Fc receptor of leukocytes and macrophages are attracted to the
C. Isograft staphylococcal protein A. The class of antibody site of complement activation by
D. Xenograft bound by this protein is A. Cl
A. IgA B. C5a
30. In Bruton disease measurement of serum B. IgD C. C8
immunoglobulins would show C. IgG D. IgM
A. Elevated levels of IgE D. IgM
B. Elevated levels of IgG 39. The type of immunity that follows the
C. Normal levels of IgG and IgM but reduced 35. A major advantage of passive immunizeation injection of an immunogen is termed
levels of IgA compared to active immunizeation is that A. Artificial active
D. The absence of all immunoglobulins A. Antibody is available more quickly B. Natural active
B. Antibody persists for the life of the recipient C. Artificial passive
31. Diagnosis of group A streptococci C. IgM is the predominant antibody class D. Innate
(Streptococcus pyogenes) infection is indicated provided
by the presence of D. Oral administration can be used
A. Anti-protein A
40. The type of immunity that follows the 45. The Venereal Disease Research Laboratory 50. Which of the following serologic tests is
injection of antibodies synthesizeed by another (VDRL) test for syphilis is classified as a(n) commonly performed by an
individual or animal is termed A. Agglutination reaction immunofluorescence method?
A. Artificial active B. Flocculation reaction A. Anti-HBs
B. Natural adaptive C. Hemagglutination reaction B. Antinuclear antibody (ANA)
C. Artificial passive D. Precipitation reaction C. Antistreptolysin O (ASO)
D. Natural passive D. C-reactive protein (CRP)
46. One cause of a false-positive VDRL test is
41. Innate immunity includes A. Brucellosis 51. The Fab portion of an antibody
A. Anamnestic response B. Treponema pallidum infection A. Binds T cell receptor
B. Antibody production C. Rocky Mountain spotted fever B. Consists of two light chains only
C. Cytotoxic T cell activity D. Systemic lupus erythematosus C. Consists of two heavy chains only
D. Phagocytosis by polymorphonuclear cells D. Contains the hypervariable reagion
47. The portion of an antigen that binds to an
42. The agglutination pattern shown in Color antibody or T cell receptor is called a(n) 52. In the enzeyme-linked immunosorbent assay
Plate 23 • was observed while performing an A. Allergin (ELISA) the visible reaction is due to a reaction
antibody titration. This agglutination pattern is B. Avidin between
an example of C. Epitope A. Enzeyme and antibody
A. A prezeone reaction D. Valence B. Enzeyme and substrate
B. A prozeone reaction C. Fluorescent dye and antigen
C. A postzeone reaction 48. Identical antibodies produced from a single D. Latex particles and antibody
D. Incomplete complement inactivation clone of plasma cells describes
A. Reagin 53. Elevated IgE levels are typically found in
43. The antibody most frequently present in B. Cold agglutinins A. Type I hypersensitivity reactions
systemic lupus erythematosus is directed against C. Heterophile antibodies B. Type II hypersensitivity reactions
A. Surface antigens of bone marrow stem cells D. Monoclonal antibodies C. Type III hypersensitivity reactions
B. Surface antigens of renal cells D. Type IV hypersensitivity reactions
C. Nuclear antigen 49. IgM antibodies react well in complement
D. Myelin fixation (CF) tests. Because of this CF tests for 54. Loss of self-tolerance results in
antibodies should A. Autoimmune disease
44. The rapid plasma reagin assay for syphilis A. Be positive early in the course of the disease B. Graft-versus-host disease
does not need to be read microscopically B. Be useful in identifying antibodies responsible C. Immunodeficiency
because the antigen is for a delayed hypersensitivity reaction D. Tumors
A. Cardiolipin C. Be useful in identifying antibodies responsible
B. Complexed with latex for anaphylactic reactions 55. A human cell with CDS on its surface is most
C. Complexed with charcoal D. Detect transplacental antibodies likely a
D. Inactivated bacterial cells A. Bcell
B. Monocyte of the following statements about skin testing is 64. The primary mechanism responsible for
C. T helper cell true? pathology in systemic lupus erythematosus is
D. Cytotoxic T cell A. A positive test depends on preformed A. Allergic reaction to foreign molecules
antibody. B. Antibodies directed against self antigens
56. Which of the following statements about B. Reactivity to a particular antigen may be C. Polyclonal activation of cytotoxic T cells
immunoglobulin light chains is true? transferred from one individual to another by D. Lack of intracellular killing after neutrophil
A. Each immunoglobulin monomer has either sensitizeed lymphocytes. phagocytosis of bacteria
one kappa or one lambda chain. C. The intensity of the response correlates
B. There are two types: kappa and lambda. directly with the clinical activity of the disease. 65. Which complement protein is present in the
C. They consist of constant regions only. D. The maximum response will occur greatest concentration in human serum?
D. They form part of the Fc fragment. immediately. A. Cl
B. C2
57. Which of the following statements applies to 61. The activity of natural killer (NK) cells C. C3
the Fc fragment of an immunoglobulin molecule? A. Does not require previous exposure to an D. C4
A. It consists of the entire heavy chain. antigen
B. It contains the variable region of the heavy B. Involves phagocytosis and killing of bacteria 66. An autoimmune disease causing destruction
chain. C. Requires interaction with cytotoxic T cells of pancreatic cells can result in
C. It contains the antigen binding sites of the D. Requires interaction with B cells A. Hashimoto disease
molecule. B. Multiple sclerosis
D. It is the region of the molecule that binds to 62. Interaction between B and T helper cells C. My asthenia gravis
receptors on various white blood cells. involves D. Type 1 diabetes
A. MHC II molecule on B cell binding to MHCI
58. Monoclonal antibodies are produced by molecule on the T cell 67. An Ouchterlony gel diffusion plate is depicted
A. Cultured T cells B. MHC II molecule on B cell binding to CDS on in Color Plate 24B. The center well contains
B. Human plasma cells the T cell antibody and the peripheral wells contain
C. Mouse plasma cells C. Foreign antigen on B cell binding to T cell antigens labeled 1 through 4. What is the
D. Hybridomas receptor relationship between the antigens in wells 2 and
D. CDS molecule on B cell binding to T cell 3?
59. Antibodies that bind to the same epitope are receptor A. 2 is part of 3.
of the same B. 3 is part of 2.
A. Allotype 63. Which of the following is a characteristic of T C. They are identical.
B. Autotype cells? D. They are unrelated.
C. Idiotype A. Synthesizee antibody
D. Isotype B. Mature in the thymus 68. An Ouchterlony gel diffusion plate is depicted
C. Able to bind unprocessed antigen in Color Plate 24B. The center well contains
60. Skin testing is a useful diagnostic tool in a D. Primarily protect against extracellular antibody and the peripheral wells contain
number of disorders such as tuberculosis. Which parasites antigens labeled 1 through 4. What is the
relationship between the antigens in wells 2 and D. Activation by antibody requires one IgM or B. RPR
4? two IgG molecules C. VDRL
A. Cannot be determined. D. FTA-ABS
B. They are identical. 73. The alternative complement pathway
C. They are unrelated. A. Can be activated by bacterial capsule 78. A serum sample is positive for HBsAg. This
D. They react incompletely with the antibody. polysaccharides result indicates that the person from whom the
B. Uses C5b as a C3 convertase serum was taken
69. Which of the following complement proteins C. Bypasses steps C3 through C5 A. Had a hepatitis B infection in the past but
is part of the membrane attack complex? D. Is inactivated by properdin overcame the infection
A. Cl B. Has either active or chronic hepatitis B
B. C3 74. A cut on a person's finger becomes infection
C. C4 contaminated with the bacterium C. Was immunizeed recently against the hepatitis
D. C5 Staphylococcus aureus. The first response by the B virus
immune system consists of activity of D. Is not infectious for the hepatitis B virus
70. Which of the following is characteristic of A. B cells
contact hypersensitivity reactions? B. Monocytes 79. What is the indicator system used in the
A. Caused by preformed IgE antibody C. Neutrophils complement fixation test?
B. Characterizeed by infiltration of neutrophils D. T cells A. Sensitizeed sheep red blood cells
into the area of reaction B. Fluorescent-labeled antihuman globulin
C. The primary symptoms often occur in the 75. Incompatible blood transfusions are C. Enzeyme-labeled antihuman globulin
respiratory tract. examples of D. Guinea pig complement
D. Usually due to a hapten A. Type I hypersensitivity reactions
B. Type II hypersensitivity reactions 80. The isotype of an immunoglobulin antibody
71. Which of the following statements about the C. Type III hypersensitivity reactions A. Is defined by the heavy chain
test for C-reactive protein (CRP) is true? D. Type IV hypersensitivity reactions B. Is defined as different alleles of the same
A. It correlates with neutrophil phagocytic antibody type (e.g. IgG)
function. 76. A soluble antigen and soluble antibody C. Is constant for all immunoglobulins of an
B. It is an indicator of ongoing inflammation. reacting to form an insoluble product describes individual
C. It is diagnostic for rheumatic fever. A. Agglutination reactions D. Is the variation within the variable region
D. Levels decrease during heart disease. B. Heterophile reactions
C. Labeled reactions 81. A patient report states the presence of serum
72. In the classical pathway of complement D. Precipitation reactions antibodies to OspC. What disease does the
activation patient most likely have?
A. C3 is activated by binding C-reactive protein 77. Which of the following is an example of a A. Syphilis
B. The sequence of activation is Cl C2 C3 C4 treponemal antigen test used for the diagnosis of B. Strep throat
C. Clq is activated by the presence of a single Fab syphilis? C. Lyme disease
region A. CRP D. Rubella
82. Patient serum is mixed with a suspension of A. Anti-HB C. The HBV vaccine stimulates liver cells to
guinea pig antigen. When the sample is then B. Anti-HBc produce antiviral molecules active against all
mixed with horse red blood cells agglutination C. Anti-HBe hepatitis viruses.
occurs. This is suggestive of an infection caused D. HBsAg D. HDV requires the host to be concurrently
by infected with HBV.
A. Borrelia burgdorferi 87. A living donor is being sought for a child who
B. Hepatitis B virus requires a kidney transplant. The best odds of 91. B lymphocytes and T lymphocytes are
C. Hepatitis C virus finding an MHC-compatible donor occur derived from
D. Epstein-Barr virus between the child and A. Hematopoietic stem cells
A. A sibling (brother or sister) B. Macrophages or monocytes
83. Hashimoto disease is an autoimmune disease B. An unrelated individual C. Mucosa-associated lymphoid tissue
primarily involving the C. The child's father D. The fetal liver
A. Kidneys D. The child's mother
B. Liver 92. Contact dermatitis is mediated by
C. Lungs 88. Cells that can act as antigen-presenting cells A. B lymphocytes
D. Thyroid gland for exogenous antigens include B. T lymphocytes
A. All nucleated cells C. Macrophages
84. Rheumatic fever sometimes occurs after B. Endothelial cells D. Polymorphonuclear cells
group A streptococcal infections. In this C. B lymphocytes
condition an autoimmune response attacks the D. T lymphocytes 93. In a competitive radioimnumosorbent test
tissue of the heart valves. This phenomenon is an (RIST) what does a high signal suggest?
example of 89. In patients with human immunodeficiency A. The patient sample has a low concentration of
A. Epitope spreading virus infection immune status can be monitored IgE.
B. Molecular mimicry by measuring the ratio of B. The patient sample has a low concentration of
C. Polyclonal B cell activation A. CD3+ cells to CD8+ cells IgM.
D. Preferential activation of T helper cells B. CD4+ cells to CD8+ cells C. The patient sample has a high concentration of
C. Lymphocytes to monocytes IgE.
85. "Superantigens" are toxins produced by some D. T cells to B cells D. The patient sample has a high concentration
strains of Staphylococcus aureus and group A of total antibody.
streptococci and cause damage by 90. Why does vaccination against hepatitis B
A. Molecular mimicry virus (HBV) also prevent hepatitis D virus (HDV) 94. An antibody titration is depicted in Color
B. Polyclonal T cell activation infections? Plate 25 •. In this titration a 0.2 mL aliquot of a
C. Lysing white blood cells and platelets A. An immunogen from HBV in the vaccine is also patient's serum sample was added to 0.8 mL of
D. Lysing red blood cells associated with HDV. saline and this mixture was placed into tube #1.
B. The HBV vaccine induces formation of A 0.5 mL sample was removed from tube #1 and
86. The first serologic marker to appear in heterophile antibodies that cross react with HDV. placed into tube #2 containing 0.5 mL of saline.
patients with acute hepatitis B virus infection is This procedure was repeated through tube #10.
The dilutions were assayed for antibody to an 97. An 11-year-old female presents with fever
infectious agent. How should the antibody titer sore throat lethargy and tender cervical 99. A 25-year-old male presents to his family
be reported? lymphadenopathy. Relevant findings include physician complaining of fatigue diarrhea and
A. 256 splenomegaly and lymphocytosis with many weight loss of a few months duration. On physical
B. 512 large reactive (atypical) lymphocytes. A examination the patient is found to have a fever
C. 640 heterophile antibody test was negative. Further and abdominal discomfort. Laboratory results
D. 1280 laboratory results were as follows: indicate a white blood cell count of 14.3 X 109/L
(reference range 4.8-10.8 X 109/L). Assays for
95. In a chemiluminescent immunologic assay HBSAg and anti-HCV are negative. An ELISA test
what is the signal detected? for antibodies to the human immunodeficiency
A. Light virus (HIV) performed on the patient's serum is
B. An electric signal found to be reactive. What step should be taken
C. A purple-colored compound next?
D. A yellow-colored compound What conclusion can be made concerning the A. Call the physician with the HIV result.
diagnosis? B. Repeat the HIV ELISA test on the sample.
96. A 28-year-old female complains to her family A. Acute CMV infection C. Test the patient's serum for anti-HBs.
physician of abdominal pain loss of appetite and B. Acute EBV infection D. Contact the patient to collect a second sample.
low-grade fever. Physical examination reveals C. Chronic CMV infection
abdominal tenderness and a low-grade fever. Her D. Chronic EBV infection 100. A 38-year-old woman visited her physician
physician orders a hepatitis profile and obtains because of fatigue fever and joint pain (proximal
the results below. 98. A male infant had been well until about 5 interphalangeal wrist and knee joints). She also
months of age at which time he was diagnosed noticed sensitivity to the sun and reported
as having otitis media and bronchitis caused by having a rash following recent exposure. The
Haemophilus influenzeae. Over the next several physician noted a rash over her nose and cheeks.
months he presented with streptococcal Laboratory results included white blood cell
pneumonia several times. At 10 months of age a count 5.5 X 109/L (reference range 4.8-10.8 X
serum protein electrophoresis showed a virtual 109/L) and red blood cell count 4.5 X 1012/L
lack of gamma globulins. Quantitative serum (reference range 4.0-5.4 X 1012/L). Urinalysis
levels were as follows: 75 mg/dL IgG and results were within reference ranges except for
Which of the following is the most likely undetectable levels of IgM IgA and IgE. There 4+ protein and 1+ RBCs 0-3 hyaline casts/lpf and
conclusion? were a normal number of T cells and they 0-1 RBC cast/lpf on microscopic examination.
A. Acute HAV infection exhibited normal mitogen stimulation. What Which of the following tests would be most
B. Acute HBV infection disease does this child most likely suffer from? helpful in diagnosing this patient's condition?
C. Chronic HBV infection A. Combined immunodeficiency A. Anti-nuclear antibody
D. Immunity to HBV due to past infection B. DiGeorge syndrome B. a-Fetoprotein
C. latrogenic immunodeficiency C. Anti-streptolysin O
D. X-linked agammaglobulinemia D. Hepatitis profile
CIULLA IMMUNOHEMATOLOGY (BB) 4. Which of the following conditions would contracting acquired immune deficiency
contraindicate autologous presurgical donation? syndrome (AIDS)?
BLOOD COLLECTION, PRESERVATION, A. Weight of 100 pounds A. Hold unit in quarantine until donor diagnosis
PROCESSING, COMPONENT PREPARATION, AND B. Age of 14 years is clarified.
QUALITY CONTROL C. Hemoglobin of 12 g/dL B. Use the blood for research dealing with AIDS.
1. A woman wants to donate blood. Her physical D. Mild bacteremia C. Properly dispose of unit by autoclaving or
examination reveals the following: weight—110 incineration.
Ib, pulse—73 bpm, blood pressure—125/75 mm 5. Which of the following donors would be D. Use the plasma and destroy the red blood
Hg, hematocrit—35%. Which of the following deferred indefinitely? cells.
exclusions applies to the prospective donor? A. History of syphilis
A. Pulse too high B. History of gonorrhea 9. Which of the following is least likely to
B. Weight too low C. Accutane® treatment transmit hepatitis?
C. Hematocrit too low D. Recipient of human growth hormone A. Cryoprecipitate
D. Blood pressure too low B. RBC
6. Which of the following viruses resides C. Plasma protein fraction (PPF)
2. A potential donor has no exclusions, but she exclusively in leukocytes? D. Platelets
weighs only 95 pounds. What is the allowable A. CMV
amount of blood (including samples) that can be B. HIV 10. A pooled sera product from 16 donors has a
drawn? C. HBV repeatedly positive nucleic acid test (NAT) for
A. 367 mL D. HCV HCV. The next action that should be taken is to
B. 378 mL A. Permanently exclude all the donors in the pool
C. 454 mL 7. A donor indicates that he has taken two aspirin B. Test each donor in the pool for HCV
D. 473 mL tablets per day for the last 36 hours. The unit of C. Label all the donors as HCV positive
blood D. Confirm the positive using recombinant
3. Donors who have received blood or blood A. May not be used for pooled platelet immunoblot assay (RIBA)
products within 12 months of when they desire concentrate preparation
to donate are deferred to protect the recipient B. Should not be drawn until 36 hours after 11. Although Cryoprecipitate has primarily been
because the cessation of aspirin ingestion used for treatment of hypofibrinogenemia and
A. Blood could have transmitted hepatitis (HBV C. May be used for pooled platelet concentrate hemophilia A, it contains other blood proteins
or HCV) or HIV preparation useful in the treatment of coagulopathies. Which
B. Blood may have two cell populations D. May be used for red blood cells and fresh- of the following is not found in Cryoprecipitate?
C. Donor may not be able to tolerate the blood frozen plasma production, but the platelets A. Fibronectin
loss should be discarded B. Factor XIII
D. Donor red cell hemoglobin level may be too C. Factor VIILvW
low 8. Which of the following best describes what D. Antithrombin III
must be done with a unit of blood drawn from a
donor who is found to be at high risk of
12. Even though it is properly collected and D. Remove sufficient segments to complete contains 50 mL with a platelet count of
stored, which of the following will freshfrozen donor processing procedures 900,000/uL.
plasma (FFP) not provide?
A. Factor V Use the following information to answer 18. What is the percent yield of platelets in the
B. FactorVIII questions 16 and 17. PRP from this unit?
C. Factor IX A satellite bag containing 250 ml_ of fresh A. 33%
D. Platelets plasma is selected for quality control of B. 45%
cryoprecipitate production. Cryoprecipitate is C. 66%
13. Blood needs to be prepared for intrauterine prepared according to standard operating D. 83%
transfusion of a fetus with severe HDN. The red procedures. The final product has a total volume
blood cell unit selected is compatible with the of 10 ml_. The factor VIII assays are 1 ILJ/mL 19. What is the percent yield of platelets in the
mother's serum and has been leuko-depleted. before and 9 ILJ/mL after preparation. final product from the PRP?
An additional step that must be taken before A. 30%
transfusion is to 16. What is the percent yield of factor VIII in the B. 45%
A. Add pooled platelets and fresh-frozen plasma final cryoprecipitate? C. 50%
B. Check that the RBC group is consistent with A. 11% D. 60%
the father's B. 25%
C. Irradiate the RBCs before infusion C. 36% 20. Does this product meet AABB Standards for
D. Test the RBC unit with the neonate's eluate D. 80% platelet concentrate production?
A. Yes
14. The addition of adenine in an anticoagulant- 17. Does this product meet AABB Standards for B. No; the count on the final product is too low.
preservative formulation aids in cryoprecipitate production? C. No; the percentage recovery in the
A. Maintaining ATP levels for red cell viability A. Yes PRP is too low.
B. Maintaining platelet function in stored blood B. No; the percent recovery is too low. D. Data are insufficient to calculate
C. Reducing the plasma K+ levels during storage C. No; the final factor VIII level is too low.
D. Maintaining 2,3-BPG levels for oxygen release D. Data are insufficient to calculate. 21. The final product was prepared with a PRP
to the tissues spin time of 2 minutes at 2500 rpm. To increase
Use the following information to answer the percent platelet yield in the final product,
15. The pilot tubes for donor unit #3276 break in questions 18—21. one would
the centrifuge. You should A centrifuge used for platelet preparation has A. Increase the time and/or rpm for the first spin
A. Label the blood using the donor's previous been returned after major repair. A unit of whole B. Increase the time and/or rpm for the second
records blood (450 mL; platelet count 200,000/ul_) is spin
B. Discard the unit because processing selected for calibration of platelet production. C. Decrease the time and/or rpm for the first spin
procedures cannot be performed The platelet-rich plasma (PRP) contains 250 mL D. Decrease the time and/or rpm for the second
C. Discard the red cells and salvage the plasma with a platelet count of 300,000/uL. The final spin
for fractionation platelet concentrate prepared from the PRP
22. When 2,3-BPG levels drop in stored blood, A. Increase in pH plasma volumes of the four units are as follows:
which of the following occurs as a result? B. Increase in plasma K+ pH 6.0, 45 mL; pH 5.5, 38 mL; pH 5.8, 40 mL; pH
A. Red blood cell K+ increases. C. Increase in plasma Na+ 5.7, 41 mL. What corrective action is needed in
B. Red blood cell ability to release O2 decreases. D. Decrease in plasma hemoglobin product preparation to meet AABB Standards for
C. Plasma hemoglobin is stabilized. platelet production?
D. ATP synthesis increases. 27. It has been determined that a patient has A. No corrective action is necessary.
posttransfusion hepatitis and received blood B. Recalibrate pH meter.
23. The last unit of autologous blood for an from eight donors. There is nothing to indicate C. Increase final plasma volume of platelet
elective surgery patient should be collected no that these donors may have been likely to concentrates.
later than hours before surgery. transmit hepatitis. What action must be taken D. Decrease final plasma volume of platelet
A. 24 initially? concentrates.
B. 36 A. Defer all donors indefinitely from further
C. 48 donations. 31. During preparation of platelet concentrate,
D. 72 B. Repeat all hepatitis testing on a fresh sample the hermetic seal of the primary bag is broken.
from each donor. The red blood cells
24. For which of the following patients would C. Notify the donor center that collected the A. Must be discarded
autologous donation not be advisable? blood. B. May be labeled with a 21-day expiration date
A. Patients with an antibody against a high- D. Interview all implicated donors. if collected in CPD
incidence antigen C. Must be labeled with a 24-hour expiration date
B. Patients with uncompensated anemia 28. The temperature range for maintaining red D. May be glycerolized within 6 days and stored
C. Open heart surgery patients blood cells and whole blood during shipping is frozen
D. Patients with multiple antibodies A. 0-4°C
B. 1-6°C 32. The blood bank procedures manual must be
25. It is generally asymptomatic but has a very C. 1-10°C A. Revised annually
high carrier rate (70-80% have chronic D. 5-15°C B. Revised after publication of each new edition
infections). About 10% of the carriers develop of AABB Standards
cirrhosis or hepatocellular carcinoma. These 29. Platelets play an important role in C. Reviewed prior to a scheduled inspection
statements are most typical of which of the maintaining hemostasis. One unit of donor D. Reviewed annually by an authorized individual
following transfusion-transmitted infections? platelets derived from whole blood should yield
A. HAV platelets. 33. Previous records of patients' ABO and Rh
B. HBV A. 5.5 X 106 types must be immediately available for
C. HCV B. 5 X 108 comparison with current test results
D. HEV C. 5.5 X 1010 A. For 6 months
D. 5 X 1010 B. For 12 months
26. Biochemical changes occur during the shelf C. For 10 years
life of stored blood. Which of the following is a 30. The pH of four platelet concentrates is D. Indefinitely
result of this "storage lesion"? measured on the day of expiration. The pH and
34. Which of the following weak D donor units facility when the blood was collected and 47. Fresh-frozen plasma, thawed
should be labeled Rh-positive? processed by a different facility? 48. Platelet concentrate in PL-732 (with
A. Weak D due to transmissible genes A. Confirmation of ABO group and Rh type of agitation)
B. Weak D as position effect blood labeled D-negative
C. Weak partial D B. Confirmation of ABO group and Rh type A. 24 hours
D. All the above C. Weak D on D-negatives B. 5 days
D. Antibody screening C. 35 days
35. In order to meet the current A ABB Standards D. 1 year
for leukocyte reduction to prevent HLA INSTRUCTIONS: Each numbered group of
alloimmunization or CMV transmission, the incomplete statements (questions 39-63) is Using the specified anticoagulant/preservative
donor unit must retain at least of the original red followed by four suggested responses. Select the (questions 49-52), indicate the allowable shelf
cells and leukocytes must be reduced to less than best answer or completion statement in each life for blood for transfusion therapy
A. 85%, 5 X 108 case. Lettered responses may be used once,
B. 80%, 5 X 106 more than once, or not at all. 49. CPD (citrate phosphate dextrose)
C. 75%, 5 X 105 50. CPDA-1 (citrate phosphate dextrose adenine)
D. 70%, 5 X 104 For the following components prepared from 51. AS-l(Adsol®)
whole blood (questions 39-43), indicate the 52. EDTA
36. Which of the following tests is/are not required storage temperature.
performed during donor processing? A. 21 days
A. ABO and Rh grouping 39. Red blood cells (RBCs), liquid B. 35 days
B. HBsAg 40. Red blood cells, frozen C. 42 days
C. HIV-l-Ag 41. Fresh-frozen plasma D. Not an approved anticoagulant
D. HBsAb 42. Cryoprecipitate
43. Platelet concentrate For the following situations (questions 53—59),
37. A 70-kg man has a platelet count of indicate whether the individual volunteering to
15,000/uL, and there are no complicating factors A. 1-6°C donate blood for allogeneic transfusion should
such as fever or HLA sensitization. If he is given a B. 20-24°C be accepted or deferred. Assume results of the
platelet pool of 6 units, what would you expect C. -18°C or colder physical examination to be acceptable unless
his posttransfusion count to be? D. -65°C or colder noted.
A. 21,000-27,000/uL
B. 25,000-35,000/uL For the following components prepared from 53. A 65-year-old man whose birthday is
C. 45,000-75,000/uL whole blood (questions 44-48), indicate the shelf tomorrow
D. 75,000-125,000/uL life.
54. A 45-year-old woman who donated a unit
38. Which of the following tests on donor red 44. Red blood cells in CPDA-1 during a holiday appeal 54 days ago
blood cells must be repeated by the transfusing 45. Fresh-frozen plasma
46. Cryoprecipitate
55. A 50-year-old man who had sex with another D. Transfusion not indicated Use the following information to answer
man in 1980 questions 68 and 69.
BLOOD GROUPS, GENETICS, SEROLOGY
56. A 25-year-old man who says he had yellow 64. Most blood group antibodies are of what A patient arrives in the OB clinic 3 months
jaundice right after he was born immunoglobulin classes? pregnant. This is her first pregnancy, and she has
A. IgA and IgD never been transfused. Her prenatal screen
57. An 18-year-old with poison ivy on his hands B. IgAandlgM includes the following results:
and face C. IgEandlgD
D. IgGandlgM
58. A woman who had a baby 2 months ago
65. The following family study is performed:
59. A 35-year-old runner (pulse 46 bpm)

A. Defer temporarily
B. Defer for 12 months All other indications are that these children are
C. Defer indefinitely both the products of this mating. Possible
D. Accept explanations for these results would include
A. A dominant inhibitor gene has been passed to
For the following patients (questions 60-63), child 1
indicate the component of choice for transfusion B. Father has one k gene and one K° gene
therapy. C. Father has the McLeod phenotype
D. Mother has a cis-Kk gene
60. Patients with warm autoimmune hemolytic 68. The test results could be due to
anemia (AIHA) due to a-methyldopa (Aldomet®) 66. Which of the following blood groups reacts A. Cold autoantibody
with hemoglobins of 8.5 g/dL or above least strongly with an anti-H produced in an AjB B. Inheritance of sese genes
individual? C. Inheritance of hh genes
61. Patients requiring transfusion with RBC that A. Group O D. Rouleaux
will not transmit cytomegalovirus (CMV) B. Group A2B
C. Group A2 69. If the patient's RBCs were tested against anti-
62. Patients with normovolemic anemia D. Group Aj H lectin and did not react, this person would be
identified as a(an)
63. Patients who are thrombocytopenic 67. How many genes encode the following Rh A. Acquired B
secondary to the treatment of acute leukemia antigens: D, C, E, c, e? B. Oh phenotype
A. One C. Secretor
A. Platelet concentrate B. Two D. Subgroup of A
B. RBC C. Three
C. Leukocyte-reduced RBC D. Four
70. If a person has the genetic makeup Hh, AO, D. The ability of plants to respond to RBC 77. An individual of the dee/dee genotype given
LeLe, sese, what substance will be found in the antigens by antibody production dCe/dce blood has an antibody response that
secretions? appears to be anti-C plus anti-D. What is the most
A. A substance 73. Which of the following sugars must be likely explanation for this?
B. H substance present on a precursor substance for A and B A. The antibody is anti-G.
C. Lea substance antigenic activity to be expressed? B. The antibody is anti-partial D.
D. Leb substance A. o-Galactose C. The antibody is anti-Cw.
B. ./V-Acetylgalactosamine D. The reactions were read incorrectly.
71. The following results were obtained when C. Glucose
typing a patient's blood sample. D. L-Fucose 78. If a patient has the Rh genotype DCe/DCe and
receives a unit of red blood cells from a DCe/dce
74. An antigen-antibody reaction alone does not individual, what Rh antibody might the patient
cause hemolysis. Which of the following is develop?
required for red blood cell lysis? A. Anti-C
A. Albumin B. Anti-c
The tech suspects that this is a case of an B. Complement C. Anti-d
acquired B antigen. Which of the following would C. Glucose-6-phosphate dehydrogenase (G6PD) D. Anti-E
support this suspicion? D. Antihuman globulin (AHG)
A. A positive autocontrol test Use the following information to answer
B. Secretor studies show that the patient is a 75. A white female's red blood cells gave the questions 79-81.
nonsecretor. following reactions upon phenotyping: D+ C+ E-
C. A patient diagnosis of leukemia c+ e+. Which of the following is the most The following results were obtained when testing
D. The patient's red cells give a negative result, probable Rh genotype? the individuals below:
with a monoclonal anti-B reagent lacking the ES- A. DCe/Dce
4 clone. B. DCe/dce
C. DCe/DcE
72. Lectins are useful in determining the cause of D. Dce/dCe
abnormal reactions in blood bank serology.
These lectins are frequently labeled as anti-H, 76. A black patient has the following Rh
anti-Ap etc. The nature of these lectins is phenotype: D+ C+ E+ c+ e+. Which of the
explained by which of the following? following genotypes is the least probable? 79. What percentage of this couple's offspring
A. An early form of monoclonal antibody A. DCE/dce can be expected to be D-negative?
produced in nonvertebrates B. DCe/DcE A. 0%
B. A plant substance that chemically reacts with C. DCe/dcE B. 25%
certain RBC antigens D. DcE/dCe C. 50%
C. Naturally occurring antibodies in certain plants D. 75%
80. Which of the following conclusions regarding discernable. A subsequent sample produces the 88. Which of the following statements is not true
the family typing is most likely? same appearance. You would suspect that the of anti-Fya and anti-Fyb?
A. The husband is not the infant's father. patient has A. Are clinically significant
B. The husband is proved to be the infant's father. A. Autoimmune hemolytic anemia B. React well with enzyme-treated panel cells
C. The husband cannot be excluded from being B. Anti-Fya C. Cause hemolytic transfusion reactions
the infant's father. C. Anti-Jka D. Cause a generally mild hemolytic disease of
D. The D typing on the infant is a false positive. D. Paroxysmal nocturnal hemoglobinuria the newborn

81. Which, if any, of these three individuals can 85. Which of the following is a characteristic of 89. Which of the following antibodies can be
make anti-D? the Xga blood group system? neutralized with pooled human plasma?
A. Husband A. The Xga antigen has a higher frequency in A. Anti-Hy and anti-Ge: 1
B. Husband and wife women than in men. B. Anti-Cha and anti-Rga
C. Wife B. The Xga antigen has a higher frequency in men C. Anti-Coa and anti-Cob
D. None than in women. D. Anti-Doa and anti-Jsb
C. The Xga antigen is enhanced by enzymes.
82. If a D-positive person makes an anti-D, this D. Anti-Xga is usually a saline-reacting antibody. 90. Which of the following statements is not true
person is probably about anti-U?
A. Partial D 86. Testing needs to be done with an antiserum A. Is clinically significant
B. D-negative that is rarely used. The appropriate steps to take B. Is only found in black individuals
C. Weak D as position effect in using this antiserum include following the C. Only occurs in S-s- individuals
D. Weak D due to transmissible genes manufacturer's procedure and D. Only occurs in Fy(a-b-) individuals
A. Performing a cell panel to be sure that the
83. A serum containing anti-k is not frequently antiserum is performing correctly 91. A patient had an anti-E identified in his serum
encountered. This is because B. Performing the testing on screen cells 5 years ago. His antibody screening test is now
A. People who lack the k antigen are rare C. Testing in duplicate to ensure the repeatability negative. To obtain suitable blood for
B. People who possess the k antigen are rare of the results transfusion, what is the best procedure to use?
C. The k antigen is not a good immunogen D. Testing a cell that is negative for the antigen A. Type the patient for the E antigen as an added
D. Kellnull people are rare and one that is heterozygous for the antigen part to the crossmatch procedure.
B. Type the donor units for the E antigen and
84. A victim of an auto accident arrives in the 87. Which of the following is a characteristic of crossmatch the E-negative units.
emergency department (ED) as a transfer from a Kidd system antibodies? C. Crossmatch donors with the patient's serum
hospital in a rural area. The patient has been in A. Usually IgM antibodies and release the compatible units for transfusion.
that facility for several weeks and has received B. Corresponding antigens are destroyed by D. Perform the crossmatch with enzymetreated
several units of red blood cells during that time. enzymes. donor cells, because enzymetreated red cells
The ED resident orders 2 units of RBCs for C. Usually strong and stable during storage react better with Rh antibodies.
transfusion. The sample sent to the blood bank is D. Often implicated in delayed hemolytic
centrifuged and the cell-serum interface is not transfusion reactions
92. A patient's red blood cells are being typed for 94. Which of the following antibodies would 96. From the cells in red cell panel chart 2,
the Fya antigen. Which of the following is the require additional testing in order to be ruled choose a selected cell panel to help identify the
proper cell type of choice for a positive control of out? antibody(ies) in the patient described in question
the anti-Fya reagent? A. Anti-E, -K, -Kpa, -Jsa, -Jkb 95.
A. Fy(a+b-) B. Anti-E, -S, -Leb, -K, -Kpa, -Fya A. 1,2,5,9,10
B. Fy(a+b+) C. Anti-E, -S, -Lea, -K, -Kpa, -Jsa, -Fya, -Jka B. 2,6,7,10
C. Fy(a-b+) D. Anti-E, -Lea, -K, -Kpa, -Jsa, -Fyb, -Jka, -Jkb C. 1,4,7
D. Fy(a-b-) D. 2,3,4,6,9
95. The most likely antibody(ies) in the patient's
93. Which of the following antibodies has been serum is(are) 97. Often when trying to identify a mixture of
clearly implicated in transfusion reactions and A. Anti-S and anti-E antibodies, it is useful to neutralize one of the
hemolytic disease of the newborn? B. Anti-E and anti-K known antibodies. Which one of the following
A. Anti-I C. Anti-Fyb showing dosage antibodies is neutralizable?
B. Anti-K D. Anti-K, anti-Jsa, and anti-Lea A. Anti-D
C. Anti-Lea B. Anti-Jka
D. Anti-N C. Anti-Lea
D. Anti-M

98. Which of the following antibodies does not

match the others in terms of optimal reactive
temperature?
A. Anti-Fya
B. Anti-Jkb
C. Anti-N
D. Anti-U

99. A recently transfused patient's serum has a

positive antibody screen. The panel performed at
IS, in LISS at 37°C, and at AHG shows a strong
anti-Fya and a weak possible anti-C. To confirm
the anti-C, you would perform an
A. Elution
B. Absorption
C. Antigen typing
D. Enzyme panel
100. The antiglobulin test does not require 104. The antibody produced during the B. Duffy
washing or the addition of IgG-coated cells in secondary response to a foreign antigen is C. Kell
which of the following antibody detection usually D. Lewis
methods? A. IgM
A. Solid-phase red cell adherence assays B. A product of T lymphocytes 109. Some antigens that are primarily found on
B. Gel test C. Produced a month or more after the second white blood cells can occur on erythrocytes.
C. Affinity column technology stimulus Which of the following are the red blood cell
D. Polyethylene glycol (PEG) technique D. Present at a higher titer than after a primary equivalents of human leukocyte antigens (HLAs)?
response A. Lea,Leb
101. Which set of antibodies could you possibly B. Bga,Bgb,Bgc
find in a patient with no history of transfusion or 105. In which situation(s) may the ABO serum C. Kpa, Kpb, Kpc
pregnancy? grouping not be valid? D. Doa,Dob
A. Anti-I, anti-s, anti-Pj A. The patient has hypogammaglobulinemia.
B. Anti-Leb, anti-Ap anti-D B. IgM alloantibodies are present. 110. The following phenotypes resulted from
C. Anti-M, anti-c, anti-B C. Cold autoantibodies are present. blood typing a mother, 6-month-old baby, and
D. Anti-Pr anti-Lea, anti-I D. All the above alleged father in a case of paternity testing.

102. Lymphocytotoxicity testing can be used to 106. A group A, D-negative obstetric patient with
detect the presence of antibodies to anti-D (titer 256) is carrying a fetus who needs an
A. Wra and Wrb intrauterine transfusion. Which of the following
B. HLA antigens units should be chosen?
C. Bga, Bgb, and Bgc A. Group A, D-negative RBC
D. JMH antigen B. Group A, D-negative whole blood
Which of the following statements is true?
C. Group O, D-negative RBC
The alleged father
103. In which of the following instances may D. Group O, D-negative whole blood
A. Is excluded by the ABO system
mixed-field (mf) agglutination be observed?
B. Is excluded by the Rh system
A. Direct antiglobulin test (DAT) result of patient 107. Which of the following is generally detected
C. Is excluded by the HLA system
undergoing delayed hemolytic transfusion at the antiglobulin phase of testing?
D. Cannot be ruled out
reaction A. Anti-Jka
B. Indirect antiglobulin test (IAT) result of patient B. Anti-M
INSTRUCTIONS: Each numbered group of
who has anti-Lea C. Anti-Pj
incomplete statements (questions 111—123) is
C. DAT result of patient on high doses of a- D. Anti-I
followed by four suggested responses.
methyldopa
D. Typing result with anti-A of patient who is A2 108. Which of the blood group systems is
Select the best answer in each case. Lettered
subgroup associated with antibodies that are generally
responses may be used once, more than once, or
IgM?
not at all.
A. Rh
Eight blood samples are received in the 123. A rare allele of M and N B. Anti-Fya is present as well as an antibody that
laboratory for ABO grouping. For each patient is reacting with an undetermined antigen on
(questions 111-118), indicate the most likely cell A. McLeod phenotype Cells #4 and #5.
and serum reactions selected from the lettered B. MS C. Ficin will enhance the reactions of the
reaction matrix. C. Kpa antibody (ies) present.
D. Ss D. Anti-Fya is present but can be ignored because
111. A patient with an acquired antigen due to most people are Fy(a-b-).
infection with gram-negative bacteria ANTIBODY IDENTIFICATION, TRANSFUSION
112. A patient with multiple myeloma THERAPY, TRANSFUSION REACTIONS 127. The serum of a patient tested with the
113. A newborn reagent red cell panel using a low-ionicstrength-
114. An A2 individual making an anti-Aj For questions 124-132, refer to red cell panel saline (LISS) additive demonstrates 3+ reactivity
115. A patient with chart 3. with Cells #1-8 at the antiglobulin phase. The
116. A patient who is immunodeficient autocontrol is negative. This pattern of reactivity
117. A patient with an unexpected IgM antibody 124. The racial origin of the donor of Cell #3 is is most likely due to
in his serum most likely A. Rouleaux formation
118. A patient with cold hemagglutinin disease A. Black B. Warm autoantibody
(CHD) B. Eskimo C. Alloantibody directed against a highfrequency
C. Oriental antigen
D. White D. Antibody directed against a preservative
present in LISS
125. The donor of Cell #5 is homozygous for
which combination of the following genes? 128. A patient's serum reacts with all the panel
A. Ce, Pp M, s, k, Jka, Fya, Leb cells except Cell #7 at the antiglobulin phase only.
B. Ce, Pj, s, k, Jka, Fya, Leb Which of the following techniques would be
C. Ce, s, k, Jle, Fya, Leb, P1 most helpful at this point?
D. Ce,s,k,Jka,Fya A. Treat the panel cells with a proteolytic enzyme
and repeat the panel with untreated serum.
For the following items (questions 119-123), 126. After testing a patient's serum with the B. Treat the panel cells with dithiothreitol (DTT)
select the answer that most closely corresponds panel, one observes there are no reactions at IS and repeat the panel with untreated serum.
to the description. or 37°C with Cells #1-8. There is a 1 + AHG C. Treat the patient's serum with dithiothreitol
reaction with Cells #1 and #6 and a 3 + AHG (DTT) and repeat the panel with treated serum.
119. Found predominantly in whites reaction with Cells #4 and #5. All other Cells, #2, D. Treat the patient's serum with a proteolytic
120. Associated with weak Kell system antigenic #3, #7, and #8, are negative at AHG. Which of the enzyme and repeat the panel with treated
expression following statements is true? serum.
121. Associated with the presence of chronic A. Anti-Fya appears to be present.
granulomatous disease
122. Linked with MN
In addition to red cell panel chart 3, use the D. Type the patient's cells for the corresponding
following information to answer questions 129- antigens.
132.
133. The following results were obtained upon
testing a specimen of a patient, being admitted
after a car accident, who had no recent history of
transfusion or medical problems.
ABO group: A
Rh type: D-positive
129. From the reactions given, it appears that
Antibody screening test: Positive, one screening
there is(are)
cell only
A. One antibody reacting
Direct antiglobulin test: Negative
B. One antibody reacting that shows dosage
Antibody identification: Anti-K identified; 3 K+
C. "Cold" and "warm" antibodies reacting
cells that reacted with the patient serum and 3
D. Two "warm" antibodies reacting
Kcells that did not react with the patient serum
were on the panel.
130. The antibody that reacts at immediate spin
Patient's cell phenotyping: K+
is most likely
What is the most likely cause of the discrepant
A. Anti-D
results?
B. Anti-P,,
A. Failure to read panel at antiglobulin phase
C. Anti-Lea
B. Failure to use positive and negative controls
D. Anti-Leb
with anti-K
C. Panel cell reactions interpreted incorrectly
131. The antibody that reacts at 37°C and with
D. Patient has circulating donor cells that Are K+
AHG is
A. Anti-C
134. False negative results at the antiglobulin
B. Anti-D
phase of an antibody screening test are most
C. Anti-CD
likely due to
D. Anti-K
A. Excessive washing of the red cells
B. Inadequate washing of the red cells
The patient is group A, D-negative and has not 132. What should you do to increase the
C. Warm autoantibody present in the patient's
probability that an antibody identification is
been recently transfused. Cells #5, #6, and #7 are serum
correct?
negative in all phases with this patient's serum. D. Failure to allow the blood to clot properly
The autocontrol is negative. Other cell results are A. Make an eluate.
B. Do saliva testing.
as follow 135. What is the process of removing an antibody
C. Run an additional panel.
from the red blood cell membrane called?
A. Absorption
B. Adsorption C. Guarantee normal survival of the red blood C. Label the specimen with information from the
C. Elution cells accompanying transfusion request form
D. Immunization D. Frequently verify donor ABO compatibility D. Request the sample be returned to the nursing
station to be labeled
136. At the end of an antiglobulin test, IgGcoated 140. Given that a patient's antibody screening
control cells are added to the negative tests and test is negative, which of the following may cause 143. A specimen of blood is received in the blood
centrifuged. What does it mean if no a false positive result in a compatibility test? bank with request slips initialled by the
agglutination occurs? A. Incorrect ABO typing of the donor or patient phlebotomist. The tube has the patient's first and
A. Test is valid. B. An alloantibody against a lowfrequency last name and medical records identification
B. Antiglobulin reagent was working properly. antigen on the donor cells number on the label. What else must be on the
C. Cells were not washed thoroughly. C. Prior coating of IgG antibody on the donor cells tube label as required by AABB Standards?
D. Control cells are contaminated. D. All the above A. Patient's room number
B. Date of phlebotomy
137. The crossmatch is performed using 141. Which of the following will be incompatible C. Initials of phlebotomist
A. Donor's serum and recipient's red cells in the crossmatch? D. Attending physician's name
B. Donor's red cells and recipient's serum
C. Donor's serum and reagent red cells 144. A physician calls the blood bank and wants
D. Recipient's serum and reagent red cells an additional unit of RBC crossmatched for a
patient. Several specimens from that patient are
138. A male trauma victim whose blood type is identified that have been drawn over the past
group AB, D-negative has a negative antibody month. Which of the following available samples
screening test. He has been transfused with both is the oldest acceptable specimen that may be
of the group AB, D-negative units in inventory used for crossmatching?
within the last hour. He is now in surgery and A. 1 day old
expected to need large amounts of blood. Of the B. 4 days old
following available units in inventory, which type C. 1 week old
should be given next? 142. A resident physician hand-delivers a blood D. 1 month old
A. 30 units of group O, D-positive sample, drawn by the attending physician, for
B. 26 units of group A, D-positive pretransfusion testing from a patient who is 145. A patient has a hemoglobin value of 8.1
C. 10 units of group O, D-negative difficult to draw. The sample is unlabeled. One g/dL. The surgeon wants to raise the hemoglobin
D. 5 units of group A, D-negative should to 10 g/dL before surgery. How many units of RBC
A. Discard the sample and request that the need to be administered to this patient to raise
139. Which of the following will the crossmatch resident obtain a new sample, adhering to the hemoglobin to the required level?
do? proper guidelines for labeling A. 1
A. Prevent immunization B. Label the specimen with the information the B. 2
B. Prevent delayed transfusion reactions resident provides C. 3
D. 4
146. A patient with an anti-K and an anti-Jka in 149. If 98% of the red blood cells are viable in a Use the following information to answer
her plasma needs 2 units of RBC for surgery. How unit of RBC at the time of transfusion, what questions 153 and 154.
many group-specific units would need to be percentage of red cells will remain viable 28 days
screened to find 2 units of RBC? The frequency of posttransfusion? A resident physician on the trauma team runs a
Jk(a+) is 77%; the K+ frequency is 10%. A. 10% pretransfusion blood sample from a male trauma
A. 6 B. 30% victim to the blood bank and wants 6 units of
B. 10 C. 50% blood to be issued immediately. He indicates that
C. 20 D. 70% he is willing to sign for uncrossmatched blood. He
D. 36 also indicates that he wants 6 units ready at all
150. What is the component of choice for times. The patient has been admitted to this
Use the following information to answer someone who needs a RBC transfusion when institution previously for GI bleed.
questions 147 and 148. there is a history of febrile transfusion reactions?
A. RBCs less than 5 days old 153. The resident says the victim has a donor
A postpartum female is bleeding because of B. Leukocyte-reduced RBCs card in his wallet indicating a group B, D-positive
disseminated intravascular coagulation (DIG). C. RBCs 30 to 35 days old blood type. What should be done immediately?
The attending physician orders cryoprecipitate D. Frozen RBCs that have been thawed and A. Issue 6 units of uncrossmatched group
for fibrinogen replacement. The freezer deglycerolized B, D-positive whole blood.
inventory contains the following cryoprecipitate: B. Check patient and donor records to confirm
6 bags Group A, 8 bags Group O, 6 bags Group 151. Which of the following is the component of the blood type, then issue 6 units of
AB, 12 bags Group B. choice when a physician is concerned about uncrossmatched group B, D-positive blood.
restoring or maintaining oxygencarrying C. Withhold blood until ABO and compatibility
147. How many bags (units) should be thawed capacity? testing are completed.
and pooled to provide 2 g of fibrinogen? A. Albumin D. Issue 6 units of uncrossmatched group O RBCs.
A. 2 B. Cryoprecipitate
B. 4 C. Whole blood 154. What should be the next step in the workup
C. 8 D. Red blood cells of this emergency department patient?
D. 10 A. Prepare 6 units uncrossmatched group B, D-
152. The serum of a patient contains an antibody positive whole blood.
148. The patient is group A. Which that reacts with all random donor cells and panel B. Check blood bank records for any previous
cryoprecipitate units would most appropriately cells that have been tested. The best possibility patient information.
be used to treat this patient? to find compatible blood would be to test C. Type and screen the patient sample.
A. Group A only A. Grandparents D. Prepare 6 more units of uncrossmatched
B. Group AB only B. Parents group O blood.
C. Group A and Group O C. Siblings
D. Group A and Group AB D. Spouse 155. Four units of fresh-frozen plasma have been
ordered to correct factor V deficiency in a group
O patient. One should thaw and issue plasma.
A. Group O only 160. Occasionally, patients have an anaphylactic B. Obtain a posttransfusion blood sample in
B. Group O and/or group A reaction to a specific immunoglobulin class EDTA.
C. Group O and/or group AB during a transfusion. Which immunoglobulin C. Obtain a posttransfusion urine sample.
D. Any blood group available class is most often implicated? D. Obtain a fresh unit from the blood bank for
A. IgA immediate infusion.
156. Which of the following is acceptable to be B. IgD
given intravenously with a blood transfusion? C. IgE 164. All paperwork checks on this transfusion
A. 5% dextrose in water D. IgG reaction are OK. The pretransfusion sample has
B. Physiologic saline straw-colored plasma. The posttransfusion
C. Ringer's solution 161. A transfusion of which of the following is sample has red-tinged plasma. This is indicative
D. Potassium chloride in saline least likely to transmit HIV, HCV, or of a(an)
HBV? A. Uncomplicated transfusion
157. Hemolytic transfusion reactions are the A. Pooled plasma, solvent/detergent treated B. Intravascular transfusion reaction
most serious type of reactions to blood B. Cryoprecipitate C. Error in which drugs have been infused with
transfusion. The majority of hemolytic C. Leukocyte-reduced RBCs the blood
transfusion reactions are caused by eiTors. D. Platelets D. Febrile transfusion reaction
A. Blood typing
B. Antibody identification Use the following information to answer 165. Although use of autologous blood
C. Clerical questions 162-164. transfusions generally has several advantages,
D. Crossmatching which of the following is not avoidable?
A transfusion reaction is reported by the nursing A. Transmission of disease
158. What type of transfusion reaction is often unit on patient A. D. The nurse reports that the B. Clerical error
diagnosed by a positive DAT and a gradual drop patient had chills, fever, and back pain within a C. Allergic reactions
in the patient's hemoglobin level? few minutes of starting the unit. The nurse asks D. Graft-versus-host disease
A. Anaphylactic what s/he should do.
B. Febrile 166. Before blood is issued for transfusion, a
C. Delayed hemolytic 162. You tell the nurse to immediately patient's previous blood bank records must be
D. Acute hemolytic A. Collect posttransfusion blood samples reviewed. Which of the following is not included
B. Monitor the pulse and blood pressure in this review process?
159. What antibody, labile both in stored serum C. Discontinue the unit, keep the line open A. ABO group and Rh type
and the patient's plasma, is a frequent cause of D. Page the patient's physician for instructions B. Clinically significant antibodies
delayed hemolytic transfusion reactions? C. Serious adverse reactions
A. Anti-A 163. Which of the following directives would not D. Hepatitis testing
B. Anti-D be included in the additional activities you would
C. Anti-Jka request the nurse to do? 167. Which of the following would not cause a
D. Anti-K A. Return the unit to the blood bank. positive hemagglutination reaction in the
crossmatch?
A. Incorrect ABO grouping of the donor patient's positive Rh control test is that the INSTRUCTIONS: Each numbered set of test
B. Unexpected antibodies in the recipient serum patient has results or conditions (questions 174—184) is
C. A positive DAT on the recipient red cells A. A positive DAT result with anti-IgG followed by four or five lettered responses.
D. A positive DAT on the donor red cells B. A cold autoantibody Select the best answer in each case. Lettered
C. Leukemia responses may be used once, more than once, or
168. Which of the following blood types D. Multiple myeloma not at all.
necessitates that a separate Rh control tube be
set up when using a monoclonal anti-D reagent? 171. A patient experiences severe rigors and goes Six units of blood from volunteer donors are
A. Group O, D-positive into shock after receiving part of a unit of RBC. tested for ABO group, Rh type, and unexpected
B. Group A, D-positive The patient's temperature, which was 37.5°C antibodies. For each set of test results (questions
C. Group B, D-positive pretransfusion, is now 40.0°C. Which of the 174-179), indicate the final disposition of the
D. Group AB, D-positive following is the most likely type of reaction? donated unit. Assume additional FDA required
A. Hemolytic testing is nonreactive, unless noted.
169. Six units of blood were ordered stat for a B. Anaphylactic
young female patient who has the following tube C. Septic
typing results (the tube typing procedure uses a D. Embolic
washed red cell suspension with monoclonal
reagents). 172. Referring to the reaction described in
The physician has just called requesting question 171, the incidence of this type of
emergency release of 2 units of RBCs. reaction is highest with which of the following
components?
A. RBC
B. FFP
C. Cryoprecipitate
D. Platelets

173. The serum of a patient transfused 2 weeks

Which of the following should be done first?
ago reacts 3+ on immediate spin and 1 + at the
A. Perform a DAT on the patient's red cells.
antiglobulin phase of testing with all reagent red
B. Tell the physician that no blood can be
cells except for the ii cell. The autocontrol reacts
released until a full work-up has been done. A. Label group O, D-positive
similarly to the panel cells. In order to
C. Begin the antibody screening test. B. Label group O, D-negative
crossmatch this patient, one should
D. Select 2 units of group O, D-negative RBCs for C. Label the RBC group O, D-positive; do not use
A. Use autoadsorbed serum
emergency release. the plasma
B. Use the prewarmed technique
D. Perform additional testing
C. Identify the antibody and obtain blood from
170. Referring to the tube typing results in E. Discard the unit
the rare donor file
question 169, the most probable cause of the
D. Use a LISS additive
For the following conditions (questions 180-184), 187. Which of the following is not considered a D. A different antibody is causing the positive
select the blood component of choice for useful predictor of hemolytic disease of the DAT.
treatment newborn (HDN) during the gestational period?
180. von Willebrand disease A. Anti-A 191. A newborn is group O, D-positive and has a
181. Hypofibrinogenemia B. Anti-D 3+ DAT. The mother's antibody screening test is
182. Factor V deficiency C. Anti-Fya negative. Assuming the antibody detection test is
183. Liver disease D. Anti-U valid, one should consider HDN due to an
184. Hemorrhagic episode during intensive antibody directed against
chemotherapy 188. Which is the class of immunoglobulin A. Fyb antigen
uniquely associated with hemolytic disease of B. K antigen
A. Platelet concentrate the newborn (HDN)? C. Low-incidence antigen
B. RBC A. IgA D. A or B antigen
C. Cryoprecipitate B. IgD
D. Fresh-frozen plasma C. IgE 192. The most conclusive way to demonstrate
D. IgG the antibody that is causing a positive DAT in a
HEMOLYTIC DISEASE (HEMOLYTIC DISEASE OF newborn is to perform an antibody
THE NEWBORN, IMMUNE HEMOLYTIC ANEMIA) 189. A neonate with a positive direct antiglobulin A. Titration using the mother's serum
test (DAT) indicates that there was an B. Panel using the mother's serum
185. Which of the following would not be incompatibility between a mother and her fetus. C. Panel using an eluate from the mother's red
included when routine testing is performed early The system that is most commonly associated cells
in a pregnancy? with an incompatibility is D. Panel using an eluate from the baby's red cells
A. ABO and Rh testing A. ABO
B. Antibody screening B. Rh 193. Which two of the following conditions are
C. Amniocentesis C. Kell the most serious immediate consequences of
D. Weak D testing on apparent Rhnegative D. Kidd HDN?
patients A. Anemia and a positive DAT
190. The cord blood of an infant of a Dnegative B. Hyperbilirubinemia and anemia
186. In which of the following blood group mother with anti-D, titer 2048, is submitted to C. Hyperbilirubinemia and j aundice
systems may the red blood cell typing change the laboratory along with a sample of maternal D. Hyperbilirubinemia and kernicterus
during pregnancy? blood with a request to select blood for possible
A. P exchange transfusion. The neonate appears to be 194. A premature infant with hydrops fetalis and
B. MNS D-negative. The weak D status cannot be a bilirubin of 20 mg/dL is referred to an intensive
C. Lewis determined because the DAT result is positive care unit. The neonatologist wants to perform an
D. Duffy (4+). What is the most likely explanation for this? exchange transfusion to correct anemia and
A. Wharton's jelly contaminated the sample. prevent kernicterus. No blood specimen from the
B. The baby has ABO HDN. mother is available. The infant's serum has a
C. The baby has a "blocked D" antigen.
positive antibody screen. The DAT is 4+. What physician ordered two units of RBCs for her 2 200. What is the total volume of FMH?
would be the best approach in this situation? days later. The antibody screening test was A. 6.5 mL
A. Identify the antibody in the serum and positive, but the crossmatches were both B. 13mL
crossmatch blood negative for the offending compatible. The most likely cause for the positive C. 26 mL
antigen, using the serum in a crossmatch. antibody screening test was the presence of D. 65 mL
B. Issue group O, D-negative blood for the a(an)
exchange. A. Clinically significant anti-K 201. With this amount of FMH, how many vials
C. Refuse to issue blood for exchange until a B. Actively acquired anti-D of a standard dose of RhIG should be
sample can be obtained from the mother. C. Passively acquired anti-D administered to the mother within 72 hours of
D. Identify the antibody in the serum and eluate D. Rh antibody other than anti-D childbirth? (Presume the infant to be D-positive.)
and crossmatch blood negative for the offending A. 1
antigen, using both the serum and eluate in a 198. What is the principle of the Kleihauer- Betke B. 2
crossmatch. stain? C. 3
A. Fetal hemoglobin is more resistant to alkaline D. 4
195. Which of the following is not true of an buffer than adult hemoglobin.
exchange transfusion when an infant is suffering B. Adult hemoglobin is more resistant to alkaline Use the following information to answer
from HDN? buffer than fetal hemoglobin. questions 202-205.
A. Removes unconjugated bilirubin C. Fetal hemoglobin is more resistant to
B. Reduces the amount of incompatible antibody erythrosin and hematoxylin staining than adult A 64-year-old female is seen in the emergency
in the baby's circulation hemoglobin. department with a hemoglobin value of 8.9 g/dL.
C. Removes antibody-coated red blood cells D. Adult hemoglobin is more soluble in acid The resident sends down a request for 2 units of
D. Provides red blood cells of the baby's type buffer than fetal hemoglobin. packed red cells. She types as group O, D-positive
using monoclonal antisera. Her ABO group and
196. A massive fetomaternal hemorrhage in a D- 199. Which of the following antibodies present in Rh type match previous records. She has not
negative woman who had a D-positive infant a multitransfused obstetric patient would be been transfused in the past 5 years. However, her
should be suspected if the most likely to cause HDN in her infant? antibody screen produces the following results:
A. Infant is premature A. Anti-Lea
B. Infant has a positive acid elution slide test B. Anti-c
C. Mother requires a transfusion following C. Anti-Pj
childbirth D. Anti-K
D. Weak D test on the maternal blood shows a
mixed-field reaction microscopically Use the following information to answer
questions 200 and 201.
197. A D-negative woman who received
antepartum RhIG gave birth to a Dpositive infant A Kleihauer-Betke acid elution stain for
and received one vial of RhIG the same day. postpartum fetomaternal hemorrhage (FMH) is
Because of postpartum hemorrhage, her reported to be 1.3%.
 B. Kell An antibody screen was performed on a 25- year-
202. What is the most likely cause for these C. Kidd old male referred to the hospital for elective
results? D. Rh surgery. Refer to the gel reactions below seen in
A. Polyagglutination an antibody screen test. (SC = screening cell, AC
B. Rouleaux 207. What is the most important consideration in = autocontrol)
C. Transfusion reaction patients suffering from life-threatening anemia
D. Warm autoantibody and whose serum contains warm
autoantibodies?
203. To demonstrate whether the antibody(ies) A. Determine the specificity of the autoantibody.
has/have become attached this patient's red B. Determine the immunoglobulin class of the
blood cells in vivo, which of the following tests autoantibody.
would be most useful? C. Exclude the presence of alloantibody(ies).
A. Direct antiglobulin test D. Avoid transfusion.
B. Complement fixation test
C. Elution procedure 208. The serum and eluate from a male patient
D. Indirect antiglobulin test with a 3+ DAT on a-methyldopa therapy 210. Which of the following is the correct
demonstrates anti-e specificity. The patient interpretation of the reaction in SC I?
204. How would you identify the antibody(ies) on denies knowledge of having received blood A. 0
this woman's cells? transfusions. To determine whether the anti-e is B. 1 +
A. Autoabsorption followed by a panel on the an auto- or alloantibody, one should C. 2+
absorbed serum A. Type the patient's red cells with a lowprotein D. 3 +
B. Elution followed by a panel on the eluate anti-e reagent
C. Enzyme-treated panel on her serum B. Adsorb the serum with the patient's red cells 211. What has happened to the matrix in SC I
D. Perform a panel on the serum. C. Adsorb the eluate with R2R2 red cells that caused a difference in its appearance from
D. Adsorb the eluate with rr red cells that of SCII?
205. What is the best treatment for this woman's A. Antibody-coated cells have been trapped in
anemia? 209. A patient has a 2+mf DAT with anti-IgG. He the gel matrix of SC I.
A. Transfusion with packed red cells was transfused 1 week ago with 2 units of RBCs B. A too heavy red cell suspension was used in SC
B. Infusion of fresh-frozen plasma during surgery. His eluate would most likely I; correct suspensions were used in SCII and AC.
C. Steroid administration contain C. Hemolysis is occurring in SC I, but not in SCII or
D. Plasma exchange A. No antibody AC.
B. Autoantibody D. SC II shows a mixed-field reaction.
206. The specificity of the antibody in warm C. Alloantibody
autoimmune hemolytic anemia (WAIHA) is most D. Drug-related antibody 212. How is cold hemagglutinin disease (CHD)
often associated with which of the following different from paroxysmal cold hemoglobinuria
blood group systems? Use the following information to answer (PCH)?
A. ABO questions 210 and 211.
A. PCH is a common form of cold autoimmune C. All panel cells treated with amethyldopa he has a negative drug history. Which of the
anemia whereas CHD is rare. D. All panel cells when oc-methyldopa is added following would most likely be present in his
B. PCH is a warm autoimmune hemolytic anemia. to the eluate eluate?
C. The offending antibody in PCH is an A. No antibody
IgG antibody unlike the IgM antibody in CHD. 216. A patient with drug-induced hemolytic B. Alloantibody
D. The offending antibody in PCH is an anemia has the following DAT results: C. Alloantibody and autoantibody
IgM antibody while an IgG antibody is common Poly specific AHG =3+ D. Autoantibody
in CHD. Anti-IgG =3+
Anti-C3d = 0 220. A patient with WAIHA has a history of an
213. If during a Donath-Landsteiner test there is Which of the following drugs is most likely to be anti-Jka in her autoabsorbed serum, and an anti-
hemolysis in both the test and control tubes at the cause? e in her eluate. Her autoabsorbed serum today is
the conclusion of the test, this indicates that the A. Phenacetin not showing anti-Jka on prewarmed panel, but
test is B. Quinidine the eluate is still showing anti-e.
A. Positive C. Penicillin What blood would be selected for crossmatching
B. Negative D. Tolmetin packed red cells today?
C. Invalid A. e-Negative
D. False negative 217. A patient with cold hemagglutinin disease B. Jk(a-)
(CHD) has a positive DAT when tested with a C. Jk(a-) and e-negative
214. A patient has a positive DAT due to polyspecific AHG. Which of the following would D. No screening is necessary because all
cephalosporin therapy and a negative antibody most likely be detected on her red cells? transfused cells will be destroyed anyway.
screening test result. Two units of RBCs have A. IgM
been ordered. In order to crossmatch this B. IgG INSTRUCTIONS: The numbered group of
patient, one should crossmatch with C. IgA incomplete statements (questions 221-228) is
A. The eluate from the patient's red cells and D. C3 followed by four suggested responses. Select the
donor cells best answer in each case. Lettered responses
B. Autoadsorbed patient's serum and untreated 218. If a patient's red blood cells are DAT+ due to may be used once, more than once, or not at all.
donor cells penicillin antibody, the
C. Untreated patient's serum and untreated A. Serum will react if penicillin is added to the For the following situations (questions 221—
donor cells test system 228), indicate whether the women are
D. Cephalosporin-treated donor cells and B. Serum will react with all red cells candidates for Rh immune globulin (RhIG)
untreated patient's serum C. Eluate will react with penicillin-coated red cells prophylaxis. Assume that D-negative mothers
D. Eluate will react with all red cells have a negative test for weak D and a nonreactive
215. A patient being treated with oc-methyldopa antibody screening test unless noted.
has a 4+ DAT result. You would expect an eluate 219. A patient's preoperative antibody screening
from his red cells to react most likely with test is negative, but the autocontrol is positive. A 221. Mother D-negative; infant weak D
A. All the untreated panel cells tested DAT performed on his red cells is 2+ with anti- 222. Mother weak D (strong); infant D-positive
B. Just the untreated D-positive cells tested IgG. His last transfusion was 9 months ago, and
223. Mother D-negative; twin #1 D-negative,
twin #2 D-positive
224. Mother D-negative with anti-Fya; infant D-
positive
225. Mother group O, D-negative; infant group A,
DAT = 2+, monoclonal anti-
D-negative at immediate spin, weak
D test not performed

226. Mother D-negative, with anti-D, titer 2,

history of RhIG injection postamniocentesis
procedure at 30 weeks; infant Dpositive

227. Female D-negative; miscarriage at 11 weeks

228. Mother D-negative; infant D-positive;

rosette test = 1—2 rosettes per field
A. Yes, 50-ug dose
B. Yes, 300-ug dose
C. Yes, additional testing necessary to determine
dose.
D. RhIG is not indicated.