Deck 21: Nonmalignant Disorders of Leukocytes: Granulocytes and Monocytes

Question 1

A patient has a fever and a WBC of 25 × 10⁹/L with bands and metamyelocytes present. Which of the following conditions describes these results?

A) Reactive leukopenia
B) Pseudoneutrophilia
C) Left shift
D) May-Hegglin anomaly

Answer 1

Left shift

Question 2

Interpret the following results: WBC count, 1.4 × 10⁹/L; bone marrow shows myeloid hypoplasia with a decreased M:E ratio of 1:1. There is no history of medications or drug exposure. What can be concluded from this?

A) The patient has a pseudoneutropenia.
B) The patient has a neutropenia resulting from decreased production.
C) The patient has a neutropenia resulting from increased loss in circulation.
D) The patient has a neutropenia resulting from toxin exposure.

Answer 2

The patient has a neutropenia resulting from decreased production.

Question 3

Which of the following can result in basophilia?

A) Chronic myeloproliferative neoplasm
B) Parasitic infections
C) Connective tissue disorders
D) All of the above

Answer 3

Chronic myeloproliferative neoplasm

Question 4

Which of the following characteristics is associated with the neutrophilia that accompanies bacterial infection?

A) Left shift
B) Toxic granulation
C) Döhle body
D) All of the above

Question 5

Which of the following is associated with bacterial infections?

A) Acute neutrophilia
B) Toxic granulation
C) Döhle bodies
D) All of the above

Question 6

A patient's smear shows clumping of neutrophils. The absolute neutrophil count shows a neutropenia. What can be done to obtain a reliable neutrophil count?

A) Shake the tube vigorously.
B) Assay the blood sample on another instrument.
C) Assay the sample after using a warm diluent.
D) Perform a finger stick and make manual dilutions and blood smears.

Question 7

A disorder characterized by a defect in glucocerebrosidase that results in a macrophage with cytoplasm appearing wrinkled or striated is:

A) Niemann Pick disease
B) Fabry's disease
C) Gaucher's disease
D) Tay Sachs disease

Question 8

A patient presents with neutrophilia of 40 10⁹/L with many circulating immature cells. The blood contains many bands, metamyelocytes, myelocytes, promyelocytes, and a rare blast. No nucleated erythrocytes are present. What disease state is most likely with these results?

A) Leukoerythroblastosis
B) Hypersensitivity reaction
C) Tissue damage from burns
D) Neutrophilic leukemoid reaction

Question 9

A patient presents with larger-than-normal neutrophils with hypersegmentation, oval macrocytes, and pancytopenia. This could be an indicator of:

A) Pelger-Huët anomaly
B) Myeloproliferative disorder
C) Megaloblastic anemia
D) Infection

Question 10

A 45-year-old male visited his physician for a routine checkup. His absolute neutrophil count was 8.5 × 10⁹/L. Which of the following terms describes these results?

A) Absolute neutrophilia
B) Intermediate neutrophilia
C) Acute neutrophilia
D) Relative neutrophilia

Question 11

Acute infection, inflammatory reaction, and administration of glucocorticosteroids can result in:

A) Basophilia
B) Eosinopenia
C) Mastocytosis
D) Histiocytosis

Question 12

The processing of a sample in a lavender top tube received in the lab at 10 a.m. is delayed because of a sudden fire drill. The sample is processed and analyzed at 2 p.m. Significant findings on this patient include an absolute neutrophil count of 1.5 × 10⁹/L. What can be concluded from this?

A) The patient is suffering from a neutropenia that needs to be investigated.
B) The delay in testing resulted in a false neutropenia.
C) The patient has pseudoneutropenia because of time of day the sample was drawn.
D) There is not enough information to draw an accurate conclusion.

Question 13

An adult patient's blood sample was collected in an EDTA blood collection tube for a CBC. The automated WBC count was 2.1 × 10⁹/L. Upon microscopic examination of the cells, the laboratory professional noted that the neutrophils adhered to the erythrocytes. What corrective action should be taken in this situation?

A) Draw the blood in heparin anticoagulant.
B) Recollect the blood from a finger stick and make manual dilutions.
C) Draw the blood in citrate anticoagulant.
D) Draw the blood in a plain red top tube.

Question 14

Which of the following anomalies is morphologically similar to toxic granulation and is often seen in patients who have poor mucopolysaccharide degradation?

A) May-Hegglin
B) Pelger-Huët
C) Chédiak-Higashi
D) Alder-Reilly

Question 15

A benign condition has the following characteristics: WBC count of 45 × 10⁹/L with a left shift and normal RBC count. What is this condition?

A) Leukoerythroblastosis
B) Pelger-Huët anomaly
C) Leukemoid reaction
D) Pyknosis

Question 16

A healthy individual has his blood drawn as a part of a routine physical. The laboratician performing the differential notes a neutrophil with a nucleus that appears dumbbell shaped. After scanning the entire slide, it appears that the vast majority of neutrophils have the same, bi-lobed nuclei with highly clumped nuclear chromatin. All other leukocytes appear normal. The conclusion from this is that the patient has:

A) May-Hegglin anomaly
B) Hypersegmented neutrophils
C) Pelger-Huët anomaly
D) Alder-Reilly anomaly

Question 17

Which of the following is most likely able to distinguish a leukemoid reaction from CML?

A) LAP score
B) Platelet count
C) Shift to the left
D) RBC count

Question 18

A patient has an elevated WBC count with many circulating leukocyte precursors and a normal RBC count. Which of the following assays provides information that can best be used to diagnose this patient?

A) Platelet count
B) Presence of myelocytes
C) Prothrombin time
D) Presence of BCR/ABL1

Question 19

A 78-year-old female receiving chemotherapy for breast cancer had a CBC performed after her last treatment. Her absolute neutrophil count was 1.0 × 10⁹/L. What information can be concluded from this?

A) The patient has a neutropenia in response to the chemotherapy.
B) The patient has a neutropenia because of bone marrow failure.
C) The patient has agranulocytosis.
D) The patient has a neutrophilia in response to the breast cancer.

Question 20

A neutrophilia that results from a redistribution of neutrophils from the marginating pool into the circulating pool is called:

A) Reactive neutrophilia
B) Intermediate neutrophilia
C) Pseudo-neutrophilia
D) Chronic neutrophilia

Question 21

What causes sea-blue histiocytosis, and how is the sea-blue histiocyte identified?

Question 22

A patient has a high fever, leukopenia, thrombocytopenia, and elevated liver enzymes. A blood smear shows WBCs with large basophilic, spherical cellular inclusions. Which of the following is a likely cause for these findings?

A) Toxic drugs
B) Ehrlichia sp. infection
C) Severe burns
D) Malaria infection

Question 23

A peripheral blood smear examination shows many WBCs with many blue-staining round inclusions. Thrombocytopenia with giant platelets is present. What autosomal dominant disease is associated with these findings?

A) May-Hegglin anomaly
B) Alder-Reilly anomaly
C) Chédiak-Higashi anomaly
D) Megaloblastic anemia

Question 24

A patient presents with splenomegaly and bone pain. Laboratory findings reveal large macrophages with small eccentric nuclei and cytoplasm with a wrinkled appearance. Further testing shows leukopenia, thrombocytopenia, and anemia. What is the probable cause?

A) Niemann-Pick disease
B) Gaucher's disease
C) Tay-Sachs disease
D) Sandhoff disease

Question 25

List three laboratory results that can distinguish a leukemoid reaction from CML.

Question 26

A 45-year-old female who returned from a trip abroad had nausea and diarrhea, and then later, muscle aches, fever, and chills. She was admitted to a local hospital and was diagnosed with the parasitic disease, trichinosis. Which of the following is most consistent with this disease?

A) Eosinophilia
B) Basophilia
C) Basopenia
D) Monocytosis

Question 27

Which of the following diseases is characterized by a defect in sphingomyelinase, which results in macrophages with a foamy appearance?

A) Gaucher's
B) Fabry's
C) Tay-Sachs
D) Niemann-Pick

Question 28

What disease state correlates highly with the presence of cytoplasmic vacuoles in freshly drawn blood?

A) Ehrlichia sp. infection
B) Septicemia
C) HIV infection
D) Malaria

Question 29

A neutrophil contains many giant gray-green peroxidase-positive bodies and giant lysosomes. Which of the following anomalies is associated with these findings?

A) May-Hegglin
B) Chédiak-Higashi
C) Pelger-Huët
D) Alder-Reilly

Question 30

A laboratician is scanning a blood smear and notices that many of the neutrophils have more than six lobes. Which of the following would be consistent with that finding?

A) A decreased vitamin B₁₂ level
B) An increased serum iron level
C) A positive DAT result
D) Decreased serum iron

Question 31

In the identification of Pelger-Huët cells, what nuclear characteristic other than the dumbbell shape aids in differentiating these cells from bands?

A) Excessive coarse clumping of chromatin
B) Lack of primary granules
C) Presence of Döhle bodies
D) Toxic granules present

Question 32

A patient presents with a leukocyte count of 120 × 10⁹/L and splenomegaly. The blood smear reveals a shift to the left with promyelocytes and blasts. The platelets are increased, and the LAP is decreased. Which condition is associated with these results?

A) Bacterial infection
B) Reactive chronic neutrophilia
C) Leukemoid reaction
D) CML

Question 33

Define leukoerythroblastosis, and name a condition in which this is seen.

Question 34

How does immediate neutrophilia differ from acute neutrophilia?

A) Immediate neutrophilia occurs within 4-5 hours of stimulus, whereas acute neutrophilia occurs within 30 minutes.
B) Immediate neutrophilia lasts 20-30 minutes, whereas acute neutrophilia lasts hours to days.
C) In immediate neutrophilia, circulating neutrophils show an increase in early neutrophil precursors, whereas acute neutrophilia has mature neutrophils.
D) In immediate neutrophilia, the leukocytes return to normal as the bone marrow production increases, whereas acute neutrophilia has mature neutrophils.

Question 35

Name a type of condition that might cause the following alterations in morphology.
a. Toxic granulation
b. Vacuolization
c. Morulae
d. Eosinophilia

Question 36

A patient presents with splenomegaly and bone pain. Laboratory findings reveal large macrophages with small eccentric nuclei and cytoplasm with a wrinkled appearance. Further testing shows leukopenia, thrombocytopenia, and anemia. How can the diagnosis be confirmed?

A) Positive Philadelphia chromosome
B) Decreased β-glucosidase activity
C) Positive for PDGFR mutation
D) Absence of cells surface adhesion proteins