TEST BANK
Rodak's Hematology: Clinical Principles and Applications
Elaine M. Keohane, Catherine N. Otto, and Jeanine M. Walenga
6th Edition
,Table of Contents
Chapter 01 An Overview of Clinical Laboratory Hematology 1
Chapter 02 Quality Assurance in Hematology and Hemostasis Testing 4
Chapter 03 Cellular Structure and Function 10
Chapter 04 Hematopoiesis 14
Chapter 05 Erythrocyte Production and Destruction 19
Chapter 06 Erythrocyte Metabolism and Membrane Structure and Function 23
Chapter 07 Hemoglobin Metabolism 27
Chapter 08 Iron Kinetics and Laboratory Assessment 32
Chapter 09 Leukocyte Development, Kinetics, and Functions 36
Chapter 10 Platelet Production, Structure, and Function 41
Chapter 11 Manual, Semiautomated, and Point-of-Care Testing and Hematology 45
Chapter 12 Automated Blood Cell Analysis 53
Chapter 13 Examination of the Peripheral Blood Film and Correlation with the Complete
Blood Count 59
Chapter 14 Bone Marrow Examination 62
Chapter 15 Body Fluid Analysis in the Hematology Laboratory 66
Chapter 16 Anemias-Red Blood Cell Morphology and Approach to Diagnosis 71
Chapter 17 Disorders of Iron Kinetics and Heme Metabolism 77
Chapter 18 Anemias Caused by Defects of DNA Metabolism 84
Chapter 19 Bone Marrow Failure 89
Chapter 20 Introduction to Increased Destruction of Erythrocytes 93
Chapter 21 Intrinsic Defects Leading to Increased Erythrocyte Destruction 98
Chapter 22 Extrinsic Defects Leading to Increased Erythrocyte Destruction-Nonimmune
Causes 105
Chapter 23 Extrinsic Defects Leading to Increased Erythrocyte Destruction-Immune
Causes 109
Chapter 24 Hemoglobinopathies (Structural Defects in Hemoglobin) 112
Chapter 25 Thalassemias 117
Chapter 26 Non-Malignant Leukocyte Disorders 122
Chapter 27 Intro to Hematologic Malignancies 128
Chapter 28 Flow Cytometric Analysis in Hematologic Disorders 133
Chapter 29 Molecular Diagnostics in the Clinical Laboratory 136
Chapter 30 Cytogenetics 139
Chapter 31 Acute Leukemias 143
Chapter 32 Myeloproliferative Neoplasms 146
Chapter 33 Myelodysplastic Syndromes 151
Chapter 34 Mature Lymphoid Neoplasms 155
Chapter 35 Normal Hemostasis and Coagulation 160
Chapter 36 Hemorrhagic Disorders and Laboratory Assessment 165
Chapter 37 Qualitative Disorders of Platelets and Vasculature 172
Chapter 38 Thrombocytopenia and Thrombocytosis 176
,Chapter 39 Thrombotic Disorders and Laboratory Assessment 182
Chapter 40 Antithrombotic Therapies and Their Laboratory Assessment 188
Chapter 41 Laboratory Evaluation of Hemostasis 193
Chapter 42 Hemostasis and Coagulation Instrumentation 201
Chapter 43 Hematology and Hemostasis in the Pediatric, Geriatric, and Pregnant
Populations 205
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
Chapter 01: An Overview of Clinical Laboratory Hematology
Keohane: Rodak's Hematology: Clinical Principles and Applications, 6th Edition
MULTIPLE CHOICE
1. Hematology is the study of:
a. blood cells.
b. serum electrolytes.
c. plasma hormone levels.
d. bacteria in the blood.
ANS: A
Hematology is the study of blood cells—red blood cells, white blood cells, and platelets.
Plasma and serum electrolytes and hormone levels are evaluated in various subdivisions of
clinical chemistry, and bacteria are evaluated in clinical microbiology.
2. The morphology of blood cells is important to evaluate:
a. every time a complete blood count (CBC) is requested on a patient.
b. when an instrument-generated flag is obtained.
c. when a profiling instrument result is abnormal.
d. when the white count is elevated.
ANS: C
Every laboratory must determine—based on its instrumentation, needs of the clinician and
other parameter flags that alert the medical laboratory scientist to the necessity for further
evaluation—when it is necessary to evaluate cell morphology. Many instrument-generated
flags, although useful, may not require review. If an automated CBC does not suggest the
need, no reason exists to evaluate the blood film, even if the white count is elevated.
3. Who is ultimately responsible for determining the specimen integrity before analysis?
a. Medical laboratory professional
b. Nursing staff
c. Phlebotomist
d. Specimen-processing personnel
ANS: A
The medical laboratory scientist is responsible for ensuring the integrity of a specimen before
analysis. Only he or she can judge whether the specimen is acceptable so that valid results can
be obtained. Acceptable criteria include such things as type of specimen for the test ordered
(e.g., blood, serum, urine); appropriate additive present (if needed) and amount of specimen
relative to the additive; time interval since obtained; and presence or absence of hemolysis,
lipemia, and other similar conditions. None of the other personnel named have the education
and understanding to fully make that judgment.
4. Hematocrit is also called:
a. white cell count.
b. bone marrow examination.
c. red blood cell (RBC) count.
d. packed red cell volume.
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
ANS: D
Historically the hematocrit was determined by centrifuging an aliquot of anticoagulated whole
blood under specified conditions (e.g., centrifugal force, capillary tube length, and bore
diameter) and then determining the ratio of the space occupied by the packed red cells
compared with that of the entire blood volume in the capillary tube, often expressed as a
percentage. Hence, it is also called the packed red cell volume.
5. The primary function of platelets is to:
a. defend the body against bacterial invasion.
b. carry oxygen to tissues.
c. facilitate blood clotting.
d. regulate acid-base balance.
ANS: C
Whenever disruption occurs to a blood vessel so that bleeding results, platelets respond
initially to stop the bleeding in small vessels; they also play an integral role in facilitating the
formation of a blood clot. White cells defend against bacterial invasion; red cells (i.e.,
hemoglobin) carry oxygen to tissues; and a complex interaction of plasma electrolytes,
proteins, and carbon dioxide participates in acid-base balance.
6. Which of the following can be evaluated only through the microscopic examination of a
stained blood film?
a. White blood cell (WBC) count
b. Reticulocyte count
c. Hemoglobin concentration
d. Presence or absence of cytoplasmic inclusions
ANS: D
Making and staining a blood film and then placing it under a microscope allow the medical
laboratory scientist to evaluate the morphology of blood cells and examine them for the
presence or absence of blood cell inclusions. These inclusions are important for cell
identification and, when abnormal inclusions are present, sometimes provide “clues” as to the
cause of disease. All the other parameters mentioned are or can be performed using an
automated hematology instrument, including reticulocyte counting.
7. Upon centrifugation of a blood specimen, the layer between the red blood cells and plasma is
called the:
a. hematocrit.
b. buffy coat.
c. serum.
d. platelet pellet.
ANS: B
When blood is centrifuged, the layer between the red cells and plasma is called the buffy coat.
This layer consists of both white blood cells and platelets. The hematocrit is the packed cell
volume that reflects the number of red blood cells. The serum is the liquid portion of the
blood formed from a clotted blood sample. The platelet pellet is a special layer of platelets
that is required for platelet function studies. This layer of platelets is prepared from a whole
blood specimen using specific centrifugation time and speed.
8. Select the term that describes a low white blood cell count.
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
a. Leukopenia
b. Leukocytosis
c. Neutropenia
d. Leukemia
ANS: A
The term leukopenia refers to a low total white blood cell count. Leukocytosis is a term that
describes an increase in white blood cell count. Neutropenia is a low cell count that is specific
to the neutrophils. Leukemia is cancer of the blood cells, most often white blood cells.
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
Chapter 02: Quality Assurance in Hematology and Hemostasis Testing
Keohane: Rodak's Hematology: Clinical Principles and Applications, 6th Edition
MULTIPLE CHOICE
1. A patient’s white blood cells (WBCs) are counted on an automated cell counter 10 times. The
mean white count is 8000/mL, and the standard deviation (SD) is 300. What is the coefficient
of variation (CV)?
a. 0.04%
b. 2.6%
c. 3.8%
d. 26%
ANS: C
% CV = (SD/mean) × 100 = (300/8000) × 100 = 3.8%.
2. What does the CV calculated in Question 2 describe about the white cell counts?
a. Accuracy
b. Reliability
c. Proper calibration
d. Precision
ANS: D
The CV is a measure of precision, or how well a result can be reproduced. It allows
comparisons of assays with different means and is a unitless number, although usually
expressed as a percentage. Accuracy is how close a result is to the true value; proper
calibration is required to obtain accuracy. Reliability is how well a method holds both
accuracy and precision over time.
3. A patient specimen is analyzed on an instrument known to be in control from previous assays
performed on a calibrated instrument and gives a hemoglobin result of 13.2 g/dL. Two hours
later it is evaluated on another instrument that is being evaluated for purchase by the
laboratory. The result is 11.8 g/dL. This result, when compared with the first, is:
a. acceptable agreement.
b. reportable.
c. precise agreement.
d. inaccurate.
ANS: D
This result is inaccurate compared with the first because it is significantly different. Precision
is not known, because multiple results are needed to determine precision; in addition,
precision must be determined using the same instrument, not between instruments. Because it
is not accurate, it cannot be reported.
4. Which is true regarding reference ranges?
a. Should be derived from reference books
b. Need to be determined only for adults
c. Can be established by running the test procedure on 10 healthy people
d. Are ranges of values for an analyte in normal healthy people
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
ANS: D
Reference ranges should be determined by evaluating a group of perhaps as many as 120
normal healthy people for the same analyte. If the analyte differs in different groups, based on
data such as age and sex, it must be determined for each group if at all possible.
5. A test that is positive in all patients who have the disease but also in some who do not have
the disease is:
a. sensitive.
b. specific.
c. precise.
d. reliable.
ANS: A
Sensitivity (diagnostic) is defined by the number of people with the disease who test positive.
In this case, all patients with the disease have a positive result, so the test is very sensitive.
The test, however, is not specific because it is also positive in some people who do not have
the disease. Reliability refers to the performance stability of a test over time. Precision
evaluates reproducibility of the result if repeated multiple times on a specimen.
6. The antinuclear antibody (ANA) test is positive in almost all people who have systemic lupus
erythematosus (SLE). It is also positive in some patients who do not have SLE. The
antideoxyribonucleic acid (anti- DNA) test is positive only in people with SLE but not in all
who do. Which of the following is true?
a. The ANA test is a good screening test, and anti-DNA test is a good confirmatory
test.
b. The anti-DNA test is a good screening test, and the ANA test is a good
confirmatory test.
c. Both are good screening tests for SLE.
d. Neither of these tests is valid.
ANS: A
Because almost all patients with SLE have a positive ANA test, it is a good screening test (if
the result is negative, it practically rules out this diagnosis for a patient). However, because
the ANA test is also positive in other patients, the anti-DNA test is a good confirmatory test,
because only patients with SLE have a positive result. In practice, the ANA test is done first;
if it is positive, then the anti-DNA test is done as follow-up. If a patient is positive with both
tests, then his or her diagnosis is SLE.
7. A purchased hemoglobin standard is used to adjust a hemoglobinometer. This standard is
being used as a:
a. control.
b. precision check.
c. delta check.
d. calibrator.
ANS: D
Standards are used to calibrate instruments. Controls are used to routinely evaluate the
accuracy of a method once it is calibrated. Precision is a measure of reproducibility, whereas
delta checks compare a patient result with a previous result (same test on the same patient).
This can only be done for a test result that essentially does not vary significantly from testing
time to testing time.
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
8. The tubing that brings the lyse reagent to the hemoglobin cuvette on an automated cell counter
is pinched and not delivering any reagent. All hemoglobin values are greater than 20 g/dL.
This represents what type of error?
a. Random
b. Imprecision
c. Constant systematic
d. Proportional systematic
ANS: C
A constant systematic error is one in which the magnitude of the error remains the same
throughout the range of the test measurement. The error is proportional if the magnitude
varies relative to the result. This is not a random error, which happens only infrequently and is
not predictable. Precision requires multiple measurements of the same specimen and evaluates
the ability to consistently reproduce the result.
9. One of two controls that have been evaluated over the last 28 days gives a result on day 29
between 2 and 3 SDs of the mean; the other control is within 2 SDs of its mean. What is the
correct procedure to follow?
a. Ignore the result unless it happens again the next day.
b. Rerun the control and, if acceptable, continue with patients.
c. Recalibrate the instrument.
d. Open new vials of controls and repeat both controls.
ANS: B
One control is acceptable, whereas the other is a warning that the method may be going out of
control. The test option in this case is to repeat the analysis of the control, and if it is
acceptable, continue with patient analysis, reporting the results. The instrument does not
appear to need recalibration because one control is acceptable and the other is within 3 SDs (1
result of 20 can acceptably be within ±3 SDs). If the repeat on the “out of control” vial is still
out between 2 and 3 SDs, then a new vial of that control should be opened and analyzed. The
control that was acceptable does need to be repeated.
10. The control values for both controls for the prothrombin test were ranging between the mean
and ±1 SD for the first 19 days of use. Starting on day 20, the values for both were
consistently between +1 and +2 SDs. This is an example of a:
a. shift.
b. trend.
c. random error.
d. predictable error.
ANS: A
If all results are consistently different from the previous in the same direction, it indicates a
shift in the methodology has occurred. A trend would show a gradual change over time. This
is neither a predictable error nor a random error because it is consistent.
11. Which would most likely be associated with the situation described in Question 11?
a. Operator error
b. Fading light source
c. Miscalibrated instrument
d. Starting a new lot number of thromboplastin reagent
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Test Bank - Rodak's Hematology: Clinical Principles and Applications, 6th Edition (Keohane, 2020)
ANS: D
Shifts can occur when a new reagent is introduced. A fading light source would lead to trend
error. If the instrument were calibrated incorrectly, both controls should be out; likewise,
operator error would result in both controls being unacceptable.
12. Which group of patients should not be included in establishing moving averages using red cell
indices?
a. Chemotherapy patients
b. Female patients
c. Obstetric patients
d. Surgical patients
ANS: A
The moving average method works well in institutions that assay specimens from generalized
populations that contain minimal numbers of sickle cell or oncology patients. This method is
not restricted in female, obstetric, or surgical patients.
13. A laboratory comparing its results to those of other laboratories on the same specimen is an
example of:
a. precision monitoring.
b. internal quality assessment.
c. external quality assessment.
d. delta checks.
ANS: C
When results are compared with those of another laboratory, this is part of external quality
assessment. Internal quality assessment is done totally within one laboratory. Delta checks
compare a patient result with a previous result on the same patient. Precision is determined by
multiple analysis of the same specimen.
14. The best way to prevent errors in the laboratory is to:
a. purchase high-quality instruments from reputable vendors.
b. hire professionals with integrity.
c. have quality management.
d. perform external quality control procedures.
ANS: B
Competent professional staff that act with integrity can ensure that the best-quality results are
routinely obtained for patients. A high-quality instrument is effective only when it is correctly
calibrated and maintained. Management, although ultimately responsible, relies on the
laboratory personnel to be aware of potential problems in assays. External quality control
programs do not guarantee the daily validity of patient results.
15. A laboratory gets numerous complaints regarding the length of time it takes hematology
results to get to the emergency department. What would be an appropriate response?
a. Make this a quality assurance project.
b. Ignore the complaints.
c. Explain why it takes so long.
d. Tell the employees to work faster.
ANS: A
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