ASCP MLS HEMATOLOGY 2024 QUESTIONS AND ANSWERS
GRADED A ASCP MLS HEMATOLOGY LATEST QUESTIONS AND
ANSWERS WITH FEEDBACK(RATIONALES)
Given the following values, which set of red blood cell indices suggests spherocytosis?
A. MCV 76 μm3 MCH 19.9 pg MCHC 28.5%
B. MCV 90 μm3 MCH 30.5 pg MCHC 32.5%
C. MCV 80 μm3 MCH 36.5 pg MCHC 39.0%
D. MCV 81 μm3 MCH 29.0 pg MCHC 34.8% - C. Spherocytes have a decreased cell
diameter and
volume, which results in loss of central pallor and discoid shape. The index most
affected is the MCHC,
usually being in excess of 36%.
Which of the following statistical terms reflects the best index of precision when
comparing two CBC parameters?
A. Mean
B. Median
C. Coefficient of variation
D. Standard deviation - C. Standard deviation(s) describes the distribution of a
sample of observations. It depends upon both the mean (average value) and dispersion
of results and is most influenced by reproducibility or precision. Because s is influenced
by the mean and expressed
as a percentage of the mean, the coefficient of variation ([s ÷ mean] × 100) can be used
to compare precision of tests with different means (e.g., WBC and RBC counts or low
vs. high controls).
Which of the following is considered a normal hemoglobin?
A. Carboxyhemoglobin
B. Methemoglobin
C. Sulfhemoglobin
D. Deoxyhemoglobin - D. Deoxyhemoglobin is the physiological Hgb that
results from the unloading of oxygen by Hgb. This is
accompanied by the widening of the space between
β-chains and the binding of 2,3-diphosphoglycerate
(2,3-DPG) on a mole-for-mole basis.
Which condition will shift the oxyhemoglobin dissociation curve to the right?
,A. Acidosis
B. Alkalosis
C. Multiple blood transfusions
D. Increased quantities of hemoglobin S or C - A. Acidosis is associated with a shift to
the right of the
oxyhemoglobin dissociation curve and, therefore, increased oxygen release (decreased
affinity of Hgb
for oxygen). Alkalosis does the opposite. Multiple blood transfusions shift the curve to
the left because the transfused blood is low in 2,3-DPG. Hgb S and Hgb C do not
change the affinity of oxygen for hemoglobin; however, many hemoglobinopathies do.
For example, Hgb Kansas causes a right shift and Hgb Chesapeake causes a left shift
of the oxyhemoglobin dissociation curve.
What is the major type of leukocyte seen in the peripheral smear of a patient with
aplastic anemia?
A. Segmented neutrophil
B. Lymphocyte
C. Monocyte
D. Eosinophil - B. Lymphocytes constitute the majority of the nucleated
cells seen. The bone marrow in aplastic anemia is spotty with patches of normal
cellularity. Absolute granulocytopenia is usually present; however, lymphocyte
production is less affected.
What is the normal WBC differential lymphocyte percentage (range) in the adult
population?
A. 5%-10%
B. 10%-20%
C. 20%-44%
D. 50%-70% - C. The normal adult percentage of lymphocytes in a white cell differential
is between 20% and 44%, although normal ranges vary by institution, patient
population, and testing methodology. This range is higher in the pediatric population.
In which age group would 60% lymphocytes be a normal finding?
A. 6 months-2 years
B. 4-6 years
C. 11-15 years
D. 40-60 years - A. There is a relative neutropenia in children from ages 4 months to 4
years. Because of this, the percentage of lymphocytes is increased in this population.
This is commonly referred to as a reversal in the normal differential percentage (or
inverted differential).
,Which of the following results on an automated differential suggests that a peripheral
smear should be reviewed manually?
A. Segs = 70%
B. Band = 6%
C. Mono = 15%
D. Eos = 2% - C. A relative monocyte count of 15% is abnormal, given
that the baseline monocyte count in a normal differential is between 1% and 8%. An
increased monocyte count may signal a myeloproliferative process such as chronic
myelomonocytic leukemia, an inflammatory response, or abnormal lymphocytes that
may have been counted as monocytes by an automated cell counter.
Which is the first stage of erythrocytic maturation in which the cytoplasm is pink due to
the formation of hemoglobin?
A. Reticulocyte
B. Pronormoblast
C. Basophilic normoblast
D. Polychromatic normoblast - D. In normal erythrocytic maturation, Hgb formation in
the late polychromatic normoblast stage gives the
cytoplasm a prominent pink coloration. The red cell continues to produce Hgb
throughout the reticulocyte stage of development.
Which of the following can shift the hemoglobin oxygen dissociation curve to the right?
A. Increases in 2,3 DPG
B. Acidosis
C. Hypoxia
D. All of these options - D. Increases in 2,3-DPG, acidosis, hypoxia, and a rise in
body temperature all shift the hemoglobin-oxygen
dissociation curve to the right. In anemia, although the number of RBCs is reduced, the
cells are more efficient at oxygen delivery because there is an increase in red cell 2,3-
DPG. This causes the oxyhemoglobin dissociation curve to shift to the right, allowing
more oxygen to be released to the tissues.
Which of the following Hgb configurations is characteristic of Hgb H?
A. γ4
B. α2-γ2
C. β4
D. α2-β2 - C. The structure of Hgb H is β4. Hgb H disease is a severe clinical
expression of α-thalassemia in which only one α-gene out of four is functioning.
Autoagglutination of red cells at room temperature can cause which of the following
abnormal test results?
, A. Low RBC count
B. High MCV
C. Low hematocrit
D. All of these options - D. Autoagglutination at room temperature may cause a
low RBC count and high MCV from an electronic counter. The Hct will be low because it
is calculated from the RBC count. Low RBC count and low Hct cause falsely high
calculations of MCH and MCHC, respectively.
Hypersplenism is characterized by:
A. Polycythemia
B. Pancytosis
C. Leukopenia
D. Myelodysplasia - C. Hypersplenic conditions are generally described by
the following four criteria: (1) cytopenias of one or more peripheral cell lines, (2)
splenomegaly, (3) bone marrow hyperplasia, and (4) resolution of cytopenia by
splenectomy.
Insufficient centrifugation will result in:
A. A false increase in hematocrit (Hct) value
B. A false decrease in Hct value
C. No effect on Hct value
D. All of these options, depending on the patient - A. Insufficient centrifugation does not
pack down the
red blood cells; therefore, the Hct, which is the
volume of packed cells, will increase.
Variation in red cell size observed on the peripheral smear is described as:
A. Anisocytosis
B. Hypochromia
C. Poikilocytosis
D. Pleocytosis - A. A mature erythrocyte is approximately 7-8 μm in
diameter. Variation in normal size is denoted by the
term anisocytosis. Hypochromia is a term that indicates increased central pallor in
erythrocytes, and poikilocytosis denotes variation in red cell shape.
Which of the following is the preferable site for bone marrow aspiration and biopsy in an
adult?
A. Iliac crest
B. Sternum
C. Tibia
D. Spinous processes of a vertebra - A. The iliac crest is the most frequently used site
for
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