Question 1

The cellularity of the marrow is best examined in a ________,and it is determined by the red bone marrow's relationship to _________.

Accepted Answer

The cellularity of the marrow is best examined in a bone marrow (BM) biopsy, and it is determined by the red bone marrow's relationship to yellow marrow. This method provides a comprehensive view of the bone marrow architecture and the proportion of hematopoietic (red) to fatty (yellow) marrow, which is crucial for assessing marrow cellularity.

Question 2

All of the following are procedures in which a bone marrow aspirate is indicated except:

Accepted Answer

Bone marrow aspirate is not indicated for diagnosing infections of known origin. It is used in other procedures such as staging malignancies, evaluating unexplained cytopenia, and making primary diagnosis of hematologic malignancies.

Question 3

The role of the hematology technologist in bone marrow evaluation is to:

Accepted Answer

The role of the hematology technologist in bone marrow evaluation is to make bone marrow smears after collection. While the technologist may assist with the bone marrow aspirate procedure, they are not typically responsible for performing it, administering anesthesia, or reporting the results to the attending physician.

Question 4

The Prussian blue stain is used to stain what element?

Accepted Answer

The Prussian blue stain is specifically designed to stain iron, as it reacts with free iron in tissue to produce a blue color. This stain is commonly used in histology and pathology to identify the presence of iron, especially in the context of diseases such as hemochromatosis or hemosiderosis.

Question 5

How many cells typically are counted when performing a bone marrow differential?

Accepted Answer

When performing a bone marrow differential, typically 1000 cells are counted to obtain a representative sample of the various cell types present in the bone marrow.

Question 6

All of the following are sites for bone marrow specimen collection except the:

Accepted Answer

The answer of All of the following are sites for...

Question 7

What is the difference between a malignant lymphoid aggregate and a benign one?

Accepted Answer

Benign lymphoid aggregates are typically well-defined and organized, reflecting the structured architecture of normal lymphoid tissue. In contrast, malignant lymphoid aggregates often appear ill-defined due to the disorganized proliferation of cancerous cells, disrupting the normal architecture.

Question 8

The presence of which of the following in the bone marrow is diagnostic for sideroblastic anemia?

Accepted Answer

The presence of ringed sideroblasts in the bone marrow is diagnostic for sideroblastic anemia. Ringed sideroblasts are erythroblasts with at least five iron granules arranged in a ring around the nucleus. These granules represent iron that has been incorporated into the mitochondria but not into the hemoglobin molecule. Other choices (A, B, and C) may be seen in different types of anemia, but do not specifically indicate sideroblastic anemia.

Question 9

A bone marrow core biopsy is received on a 10-year-old male patient suspected of having aplastic anemia.The pathologist reviews the smear and concludes the overall cellularity to be 22% with an M:E ratio of 2.5:1.Is the patient likely suffering from aplastic anemia? Why or why not?

Accepted Answer

Aplastic anemia is characterized by a hypocellular bone marrow, which is reflected by the low overall cellularity seen on the biopsy. The M:E ratio may not always correlate well with the diagnosis, but a normal ratio in this case does not exclude the possibility of aplastic anemia. Therefore, the patient is likely suffering from aplastic anemia based on the low overall cellularity in the bone marrow core biopsy.

Question 10

The primary location for bone marrow collection depends on which two factors?

Accepted Answer

The answer of The primary location for bone marrow collection...

Question 11

Which of the following is an expected finding in the bone marrow in a patient with the following results: serum iron = 124 mcg/dL (reference range: 35-170 ug/dL);TIBC = 284 mcg/dL (reference range: 225-425 mcg/dL)?

Accepted Answer

A serum iron level of 124 mcg/dL within the reference range indicates adequate iron supply. A TIBC level of 284 mcg/dL within the reference range indicates normal binding capacity of transferrin, which transports iron. Therefore, an expected finding in bone marrow would be adequate iron stores with Prussian blue stain. Sea blue histiocytes are found in certain conditions like Gaucher disease, Niemann-Pick disease or myeloproliferative neoplasm. Increased iron stores would be seen with elevated serum iron and saturation levels, and it would not be expected in this case where the serum iron and TIBC levels are within the normal range. Decreased or absent Prussian blue specks would be seen in conditions like anemia of chronic disease, where iron is sequestered within the macrophages and not utilized for erythropoiesis.

Question 12

The cellularity of the bone marrow is determined by examining the ratio of:

Accepted Answer

DThe cellularity of the bone marrow is determined by examining the ratio of adipose tissue to hematopoietic cells (C) and the ratio of hematopoietic cells to non-hematopoietic cells (D). These ratios help assess whether the bone marrow is functioning properly and producing an appropriate amount of blood cells, as well as the balance between the different types of tissues within the marrow.

Question 13

What is the overall cellularity range of a bone marrow in a 35-year-old female patient?

Accepted Answer

The overall cellularity range of a bone marrow varies with age and sex. In a healthy adult female, the cellularity range is typically between 55-75%. Therefore, option B is the correct answer.

Question 14

If a bone marrow aspiration results in a dry tap,or when the marrow aspirate lacks spicules,the best source for studying cellular detail and maturation sequence is

Accepted Answer

Touch imprints of the core biopsy are the best choice when a bone marrow aspiration results in a dry tap or lacks spicules. Touch imprints provide a way to study the cellular details and maturation sequence of the bone marrow without the need for a liquid aspirate. Core biopsy washings and reaspiration of marrow may also be options, but touch imprints are the preferred method. Histologic embedded paraffin blocks are not useful in this scenario because they require the presence of tissue, not just cells.

Question 15

A differential is performed on a bone marrow specimen obtained from a patient suspected of having CML in blast crisis.The results are as follows: 45% blasts,13% metamyelocytes,18% myelocytes,10% promyelocytes,8% bands,2% segmented neutrophils,1% pronormoblasts,1% basophilic normoblasts,1% polychromatophilic normoblasts,and 1% orthochromatophilic normoblasts.What is the M:E ratio?

Accepted Answer

To calculate the M:E ratio, we add up the numbers of all the types of mature cells (myelocytes, metamyelocytes, bands and segmented neutrophils) and divide by the number of blasts. 
Mature cells = 13% + 18% + 8% + 2% = 41%
M:E ratio = Mature cells : Blasts = 41 : 45
M:E ratio = 24:1

Question 16

A low M:E ratio in a patient represents what possible process?

Accepted Answer

The answer of A low M:E ratio in a patient...

Question 17

Which of the following indicates a reason for performing cytochemical staining on bone marrow specimens of suspected hematologic dyscrasias?

Accepted Answer

Cytochemical staining is used to identify specific enzymes and proteins in cells, which can aid in identifying the lineage of hematopoietic cells in bone marrow specimens. This can provide higher specificity for differentiation than standard morphology alone.

Question 18

It has been determined that the M:E ratio of a 55-year-old patient is 12:1.What can be concluded about the cellularity of the bone marrow?

Accepted Answer

The M:E (myeloid to erythroid) ratio of 12:1 indicates myeloid hyperplasia, as the normal M:E ratio ranges from 2:1 to 4:1, suggesting an increase in myeloid lineage cells.

Question 19

A 2-year-old boy is suspected of having leukemia,and a bone marrow examination is requested.From which body site should the bone marrow be collected?

Accepted Answer

For young children, the preferred site for bone marrow aspiration is the tibia. This is because the tibia has a greater amount of red bone marrow than the other options listed, making the procedure easier and more likely to yield sufficient quantity and quality of bone marrow cells for analysis. Additionally, this site has fewer associated risks and complications than other sites, such as the sternum or vertebrae.

Question 20

The M:E ratio is determined by examining the relationship between:

Accepted Answer

The M:E ratio is determined by examining the relationship between all granulocytic precursors and nucleated erythroid precursors. This ratio is used in hematology to assess bone marrow function and to help diagnose various hematological disorders.

Quiz 38: Bone Marrow Examination

The cellularity of the marrow is best examined in a ,and it is determined by the red bone marrow's relationship to _.