Why is it important that synthesis of globin chains and heme be balanced in the RBCs?

An excess of one of the components of hemoglobin decreases RBC survival.

What is the mechanism for ACI?

Acute phase reactants impair iron mobilization.

Four large corner squares of a hemocytometer: 95, 102, 105, and 98 WBCs. 1:20 dilution. Interpret WBC count from values.

Normal for infant and elevated for an adult

MCV on patient 115 fL. MCHC is 35 g/dL. What must be true of the MCH to be consistent with 2 previous indices?

Should be ABOVE reference range.

Q26 on CH11, too big for this.

Multiply the result from the standard curve by 2.

Interpret following results on an adult female.RBC: 3.22 × 1012/L Hemoglobin: 16.0 g/dLHematocrit: 30.0%

Values don't agree with rule of 3

What is the mechanism for iron toxicity if iron is present in excess amounts?

Acts as a catalyst in forming hydroxyl (free) radicals.

Which could cause the microhematocrit to be falsely decreased?

Introduction of interstitial fluid

Which correctly describes the structure of normal hemoglobin A (Hb A)?

Two alpha and two beta polypeptide chains, each containing one heme group

The A1c-modified component of Hb A is increased in what condition?

uncontrolled diabeetus mellitus

Why is testing the ESR not recommended when testing for inflammation in asymptomatic individuals?

It is not a reliable predictor of inflammation.

Why does Hb F have a higher oxygen affinity than adult hemoglobin?

It is necessary to extract oxygen from the maternal blood supply.

Manual WBC count at 1:20 dilution. Four large corners mm2 counted. 8, 12, 9, 11 WBCs counted. What's next step?

Count the cells in all 9 mm2 of the hemocytometer

Which is true of the oxygen dissociation curve?

Shift to right or left in response to blood pH is called the Bohr effect.

Why is too much iron dangerous?

Free radicals and superoxide can form,plus oxygen damage tocell membranes.

How do sickle cells or spherocytes interfere with the ESR?

Prevent rouleaux formation, so falsely decrease

Most likely Dx for a 10-month-old child fed only cow’s milk with these results?Iron & Ferritin decreased, TIBC increased

Iron deficiency from increased need and inadequate diet

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Hematology Exam 3 (7,8,11,17)

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Answers

1
Std reticulocyte prep methylene blue, 100/1000 cells with granulofil; RBC = 3.22x10^12/L, Hct=30%. Calc MCV.
93 fL
98 fL
108 fL
80 fL
2
The serum ferritin is used more often than bone marrow or liver biopsies to assess iron stores because it is:
More accurate
more precise
less invasive
more direct measurement
3
How much iron do adult men need a day?
0.5 mg
1.0 mg
1.5 mg
2.5 mg
4
Methylene blue, 100/1000 cells have granulofil. RBC count = 3.22x10^12/L, Hct = 30%. Calc corrected retic count as %.
15.0%
3.0%
6.7%
1.5%
5
Why is it important that synthesis of globin chains and heme be balanced in the RBCs?
Excess concentration of protoporphyrin increases bilirubin in plasma.
Excess of Hgb components increase RBC survival, causes RBC to go up
Excess globin chains drops conc. of globin chain mRNA in maturing RBCs
An excess of one of the components of hemoglobin decreases RBC survival.
6
The calculated indices on the patient from Question 9 are: MCV (fL) MCH (pg) MCHC (g/dL)
93,50,53
105,34,35
105,29,37
93,22,28
7
20 cells counted in one of nine large squares of hemocytometer. Sample diluted 1:10. # of cells present per μL?
1000
200
2000
20,000
8
What is the mechanism for ACI?
Bone marrow iron stores are depleted by acute phase reactants.
Cytokines prevent iron incorporation into protoporphyrin.
Inflammation and infections slow heme development.
Acute phase reactants impair iron mobilization.
9
Which two organs are the major storage sites for iron in a normal individual?
SPleen and heart
Liver and spleen
Lymph nodes and muscle
Bone marrow and pancreas
10
Chronic blood loss leads to:
Iron Deficiency Anemia
Megaloblastic anemia
Hemolytic anemia
ACI
11
Four large corner squares of a hemocytometer: 95, 102, 105, and 98 WBCs. 1:20 dilution. Interpret WBC count from values.
Elevated for any patient
Normal for an infant and decreased for an adult
Normal for any patient
Normal for infant and elevated for an adult
12
MCV on patient 115 fL. MCHC is 35 g/dL. What must be true of the MCH to be consistent with 2 previous indices?
Impossible to know
Should be ABOVE reference range.
Should be BELOW reference range
Should be IN the reference range
13
Q26 on CH11, too big for this.
Add results from the turbid and second dilution together and divide by 2
Multiply the result from the standard curve by 2.
There was no reason to perform this second dilution
Divide the result obtained from the graph on the diluted specimen by 2.
14
What's the affinity of Hgb for oxygen in lungs/tissue with a normal dissociation curve?
High in Lungs, High in Tissue
Low in lungs, high in tissue
High in lungs, low in tissue
Low in lungs, low in tissue
15
Select the form of hemoglobin that contains iron in the ferric rather than the ferrous state.
Carboxyhemoglobin
Deoxyhemoglobin
Myoglobin
Methemoglobin
16
Manual cell counting methods in automated hematology laboratories are used for all of the following except:
very low counts
routine testing
malfunctioning automated instruments.
field testing in a disaster
17
Which red cell indices support macrocytic normochromic red cell morphology? MCV (fL) MCH (pg) MCHC (g/dL)
68, 22, 28
120, 36, 35
75, 30, 34
90, 30, 34
18
Interpret following results on an adult female.RBC: 3.22 × 1012/L Hemoglobin: 16.0 g/dLHematocrit: 30.0%
Hgb is elevated and other two are normal
All are decreased
Values don't agree with rule of 3
All are normal
19
Which regulatory standards mandate the concept of “test site neutrality” for all laboratory procedures?
Joint Commission
CLIA
CAP
OSHA
20
Which would point to iron deficiency anemia as opposed to the ACI?
Anemia
Elevated FEP
High Transferrin
Low Serum Iron
21
Which is true of stage 3 iron deficiency?
The red cell count is increased, whereas the hematocrit is decreased
The number of sideroblasts is normal
Serum transferrin receptors are decreased.
FEP is increased.
22
Std reticulocyte prep methylene blue, 100/1000 cells with granulofil; RBC = 3.22x10^12/L, Hct=30%. Calc RPI.
2.7
13.4
1.5
3.4
23
Ringed sideroblasts are a reflection of iron-laden:
ribosomes
Golgi complex
rough ER
mitochondria
24
Lack of accessible iron is the mechanism for iron deficiency in which condition?
Hemochromatosis
Hemosiderosis
Anemia of chronic inflammation
Lead poisoning
25
What is the mechanism for iron toxicity if iron is present in excess amounts?
Impedes hematopoiesis.
Interferes with globin synthesis.
Acts as a catalyst in forming hydroxyl (free) radicals.
Reduces hemoglobin to methemoglobin.
26
Which could cause the microhematocrit to be falsely decreased?
insufficient centrifugation
dehydration
trapped plasma from abnormally shaped RBCs
Introduction of interstitial fluid
27
10 NRBCs found in blood film WBC Diff. What's the corrected WBC count with cell counter of 10x10^9 / L?
Ten NRBCs are not enough to require a correction
91 × 109/L
0.91 × 109/L
9.1 × 109/L
28
Which correctly describes the structure of normal hemoglobin A (Hb A)?
Four identical polypeptide chains, each containing two heme groups
Conjugated protein with 141 amino acids, containing two atoms of iron
Two alpha and two beta polypeptide chains, each containing one heme group
Two delta and two gamma polypeptide chains, each a single heme group
29
Heme is composed of iron and what?
Methemoglobin
Oxygen
protoporphyrin IX
Globin chains
30
The A1c-modified component of Hb A is increased in what condition?
Sickle cell anemia
Thalassemia
uncontrolled diabeetus mellitus
Disorders of heme
31
Which causes a shift to the right on the oxygen dissociation curve?
Decreased levels of 2,3-biphosphoglycerate (2,3-BPG)
Severe Anemia
Alkalosis
High levels of Hb F
32
What parameter of the routine complete blood count (CBC) is a sensitive indicator of preclinical iron deficiency?
MCH
RDW
RBC count
Hct
33
Why is testing the ESR not recommended when testing for inflammation in asymptomatic individuals?
It is not a reliable predictor of inflammation.
It is not affordable to most people.
It is too complicated and time-consuming.
It yields too many false-negative results
34
Why does Hb F have a higher oxygen affinity than adult hemoglobin?
It is necessary to extract oxygen from the maternal blood supply.
Fetal blood has a higher pH than adult blood.
Fetal blood has a higher hematocrit than adult blood.
Body temperature is lower in fetus.
35
Which stains blue with the Prussian blue stain?
Both Ferritin and Hemosiderin
Hemosiderin
Transferrin
Ferritin
36
What is the plasma carrier protein for iron?
Apoferritin
Hemosiderin
Albumin
Apotransferrin
37
Manual WBC count at 1:20 dilution. Four large corners mm2 counted. 8, 12, 9, 11 WBCs counted. What's next step?
Count the cells in all 9 mm2 of the hemocytometer
Redo the dilution of blood using a new 1:20 dilution
Redo the dilution of blood using a 1:100 dilution.
Calculate the count using the values from the 4 mm2 and report the result
38
Methylene blue, 100/1000 cells have granulofilamentous. RBC count = 3.22x10^12/L, Hct = 30%. Calc ABS retic count as %.
3.2 x 10^12 / L
0.32 x 10^12 / L
32.2 × 10^12 / L
0.99 x 10^12 / L
39
Soluble transferrin receptor (sTfR) levels increase when intracellular iron levels are:
Elevated
Decreased
Constant
both decreased and elevated
40
Which is true of the oxygen dissociation curve?
A shift to the left results in lower oxygen affinity.
Shift to right or left in response to blood pH is called the Bohr effect.
Normal PO2 at which hemoglobin is 50% saturated is 20 mm Hg.
Shift to the right results in less effective delivery of oxygen to tissue.
41
The globin chains making up Hb A are:
two epsilon and two gamma chains.
two alpha and two beta chains.
two alpha and two gamma
two sigma and two epsilon chains.
42
Why is too much iron dangerous?
Iron’s breakdown products cause excretion of vitamins C and E.
Transferrin, which carries iron, causes cellular swelling and lysis.
The oxygen carried by excess iron oxidizes neurologic cells.
Free radicals and superoxide can form,plus oxygen damage tocell membranes.
43
How do lead exposure and the porphyrias cause anemia?
Impaired iron absorption
Chelate iron from body
Cause destruction of RBCs
Interfere with heme production
44
Where is heme produced?
Liver
Mature RBCs in peripheral circulation
RBC precursors in bone marrow
Macrophages in bone marrow
45
Which red cell indices support normocytic normochromic red cell morphology? MCV (fL) MCH (pg) MCHC (g/dL)
120, 36, 35
90, 30, 34
68, 22, 28
75, 30, 34
46
Which red cell inclusion is often found in lead poisoning?
Heinz bodies
Basophilic stippling
Cabot rings
Howell-Jolly bodies
47
How do sickle cells or spherocytes interfere with the ESR?
Prevent rouleaux formation, so falsely decrease
Agglutinate and increase red cell mass, so falsely increase
Encourage rouleaux formation, so falsely increase
Decrease plasma viscosity, so falsely decrease
48
What should the laboratory technician do before working with hemoglobin reagent?
consult the SDS
Stop working with the reagent.
Discard the reagent in the sink
Call the reagent manufacturer
49
Good dietary sources of iron include all of these except:
Fortified flour
Meat
legumes
Fruit
50
Most likely Dx for a 10-month-old child fed only cow’s milk with these results?Iron & Ferritin decreased, TIBC increased
chronic disease
Iron deficiency from increased need and inadequate diet
iron deficiency from chonic blood loss
Lead poisoning
51
Identify the primary organelle of synthesis site for globin chain and heme in developing RBCs. Globin chains Heme
Golgi complex mitochondria
Ribosomes mitochondria
Ribosomes ribosomes
Mitochondria Golgi complex
52
Which characterizes stage 1 iron deficiency? Anemia, MCV, Ferritin
Present, Decreased, Decreased
Present, Normal, Normal
Absent Decreased Normal
Absent, Normal, Decreased
53
The reference range for hemoglobin concentration:
higher in a newborn than in a male adult
higher in a newborn than a male adult
lower in a newborn than a male adult
lower in a newborn than a female adult
54
What is the total volume of one side of a hemocytometer if the ruled area is 3 × 3 mm and the depth is 0.1 mm?
9 mm^3
0.9 mm^3
0.3 mm^3
1.0 mm^3
55
Which is the best test to distinguish iron deficiency anemia from ACI?
Hemoglobin
Free erythrocyte protoporphyrin (FEP)
Ferritin
Serum iron
56
Which promotes increased iron absorption?
Deseerrioxamine
Repeated phlebotomy
Diet high in ascorbic acid
Vegetarian Diet
57
Which result is typical in stage 3 iron deficiency anemia?
Low MCV
Elevated reticulocyte percentage
Macrocytic red cells
Thrombocytopenia
58
Which are typical laboratory results for ACI?
Low Serum Iron, Low TIBC
Decreased ferritin and bone marrow Prussian blue staining
Increased transferrin sat, decreased FEP
Low serum iron, high TIBC
59
1:20 dilution made for WBC count. Count from 4 large corners = 12, 28, 18, and 15. What should you do next?
Increase numbber of mm^2 squares counted
Clean hematocytometer and recharge with well-mixed dilution
Compare this cell count ot the one on the other side.
Report white count of 3.7x10^9/L
60
Which red cell indices support microcytic hypochromic red cell morphology? MCV (fL) MCH (pg) MCHC (g/dL)
120, 36, 35
90, 30, 34
75, 30, 34
68, 22, 28
61
Which is true regarding carboxyhemoglobin?
It has hydrogen sulfide added to hemoglobin
Smokers have increased levels.
Normal people have none.
Levels of 15% to 20% cause coma and death
62
Which can cause a falsely increased ESR?
Tuberculosis
Increased plasma viscosity
Tube not totally vertical
Concentration of anticoagulant increased
63
Most likely finding if bone marrow aspiration were performed in a complicated case of iron deficiency anemia?
Shaggy polychromatophilic normoblasts and no staining with Prussian blue
Increased M:E ratio and increased staining with Prussian blue
Increased M:E ratio and increased ringed sideroblast
Polychromatophilic N-blasts, pink cytoplasm, no staining with Prussian blue
64
What is the effect of an increased concentration of 2,3-BPG in the RBC?
Shifts the oxygen dissociation curve to the right.
Increases the affinity of hemoglobin for oxygen.
Decreases the synthesis of globin chains
Puts hemoglobin in the relaxed conformation.
65
The serum iron and TIBC results given in Question 7 are consistent with what? Serum Iron = 10g/dL, TIBC=400g/dL, % sat=2
acute infection
iron toxicity
iron deficiency
iron overload
66
Diagnostic testing at or near the site of patient care is known as:
Preanalytical testing
POC testing
CLIA testing
Waived testing
67
Which is true of hemoglobin if the oxygen dissociation curve shifts to the left?
Picks up less oxygen in the lungs but delivers more to tissues.
Has a lower affinity for oxygen.
Picks up more oxygen in the lungs but delivers less to tissues.
Picks up and delivers more oxygen.
68
Which group of patients is most likely to develop iron deficiency from increased need?
Infants and young children
Middle-aged men
Postmenopausal women
Young men
69
Which is decreased in patients with hereditary hemochromatosis?
Transferrin saturation
Ferritin
Serum Iron
Albumin
70
PLT count = 80×10^9/L. PLTs satelite around Neutros, Sodium citrate tubes reads 300x10^9/L. Which PLT count reported?
330
300
Estimated count from blood film
80
71
The following hemoglobins are found in a normal human adult except:
hemoglobin Gower-2
Fetal hemoglobin (HbF)
HbA
Hb A2
72
Why is it important to have a scrupulously clean hemocytometer when manually counting platelets?
they are easily confused with the red cells that are present
They are so refractile they can be confused with dirt.
So few platelets exist that they can be missed if dirt is present.
Their small size makes them easily confused with dirt.
73
Which statement is true about Hb F?
It has a low oxygen affinity
It is evenly distributed at low concentration in all RBCs of an adult.
It is increased in concentration in children up to 2 years old.
It is the major hemoglobin during fetal life.
74
How many molecules of oxygen can one molecule of hemoglobin carry?
1
2
3
4
75
In which condition would patients have an increased concentration of methemoglobin?
Patient receiving drug containing sulfonamide
Patient exposed to reducing agents
Patient with hemoglobin S (Hb S)
Patient with methemoglobin reductase deficiency
76
Patient serum iron = 10 g/dL, TIBC = 490 g/dL. What is the percent saturation of transferrin?
2%
60%
40%
25%
77
Why is lead poisoning of particular concern in children?
FEP may accumulate
Severe anemia may develop
Impaired mental development may occur
Secondary iron deficiency may develop
78
Which provides a negative feedback for heme synthesis, thus helping to control, by decreasing, its synthesis?
Concentration of globin chain in the developing RBC
Concentration of hemoglobin in blood
Concentration of heme in the developing RBC
Number of RBCs in circulation
79
Center square L side of hemocytometer, 100 PLTs found; 200 found in center square other side. Best course of action?
Recount the hemocytometer on a phase microscope.
Verify the count by estimating the platelet number on the blood film.
Report the count as 150 × 109/L.
Repeat the procedure—the two counts are not close enough.
80
Methylene blue prep, 100/1000 cells have granulofilamentous. RBC count = 3.22x10^12/L, Hct = 30%. Calc Retic count as %.
10.0%
1.0%
0.1%
100.0%
81
24-hour assessment of iron that's available for hemoglobin production is best identified by measuring the:
amount of hemoglobin in reticulocytes
sTfR levels on the cell membrane
zinc protoporphyrin levels in RBCs
Amount of hemosiderin with Prussian blue stain
82
Which is a good use of the erythrocyte sedimentation rate (ESR)?
Monitor patients with rheumatoid arthritis.
Diagnose multiple myeloma
Monitor patients with osteoarthritis
Diagnose acute appendicitis
83
Which test rises first after successful treatment for iron deficiency?
Ferritin
Reticulocyte count
Hemoglobin
MCV
84
Why is heme located inside a globin chain pocket surrounded by hydrophobic amino acids?
Protects iron from being oxidized to its ferric form.
Makes hemoglobin insoluble.
Keeps heme from being dissolved.
Necessary for oxygen release to tissues.
85
Where is most of the iron in the body found?
Attached to hemoglobin in the red blood cells (RBCs)
Myoglobin
Stored in macrophages in the bone marrow
Attached to transferrin
86
Most of the clinical findings in the porphyrias are related to:
iron being unvailable
anemia
Reduction in heme production
accumulated porphyrin compounds in tissue
87
Ringed sideroblasts are seen in:
Inherited sideroblastic anemia
ACI
Acquired hemochromatosis
Iron deficiency anemia
88
Transfusion-related hemochromatosis is seen in patients who:
received the wrong type of blood.
had an adverse reaction to a blood transfusion.
had repeated red blood cell transfusions.
received a transfusion from a relative.
89
Which is true of apotransferrin?
It binds to a ferritin receptor found on the cell membrane
It is synthesized in the kidney.
It is normally about 50% saturated with iron
It can bind two molecules of ferric iron.
90
An increase in the concentration of 2,3-BPG:
is present in patients with severe anemia and decreased blood pH (acidosis)
shifts the oxygen dissociation curve to the left.
increases the affinity of hemoglobin for oxygen.
puts hemoglobin the relaxed conformation form
91
Condition where acute increase in ferritin is detected without a specific increase in systemic body iron.
Malignancy
Myocardial infarction
Liver disease
Infection
92
All are true about hepcidin except that:
It's an acute phase reactant
It's a hormone
Decreases in response to increased ferritin
Increases in response to increased iron stores
93
Where is the largest percentage of iron in the body located?
Stored in the bone marrow
Stored in the liver
In the cytoplasm of macrophages
Attached to hemoglobin in erythrocytes

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