Deck 10: The Complete Blood Count and Peripheral Blood Smear Evaluation

Question 1

Which RBC inclusion is characterized by diffusely staining RNA precipitate that can be seen when blood is stained with Wright's stain?

A) Heinz bodies
B) Pappenheimer bodies
C) Howell-Jolly bodies
D) Basophilic stippling

Answer 1

Basophilic stippling

Question 2

Platelet estimates are usually performed on a blood smear using which microscopic magnification?

A) 10x
B) 100x
C) 400x
D) 1000x

Answer 2

1000x

Question 3

Which of the following represents the correct units for reporting an absolute reticulocyte count?

A) 15 × 10⁹/L
B) 15 × 10³/L
C) 15%
D) 15 × 10¹²/L

Answer 3

15 × 10⁹/L

Question 4

An instrument printout indicates an MCV of 63 fl and an MCHC of 26 g/dl. How will the red cells appear under the microscope?

A) Normocytic, normochromic
B) Macrocytic, normochromic
C) Microcytic, hypochromic
D) Normocytic, hypochromic

Question 5

Which poikilocyte is indicated by the arrows in the following image?

A) Spherocytes
B) Macrocytes
C) Schistocytes
D) Elliptocytes

Question 6

How does the mean cell volume value classify cells?

A) Normochromic, hypochromic, and hyperchromic
B) Normocytic, microcytic, macrocytic
C) Poikilocytosis
D) Polychromasia

Question 7

The hemoglobin and hematocrit on a newborn are 18.9 g/dL and 60%. How would you interpret these data?

A) Lower than expected on a newborn
B) Higher than expected on a newborn
C) Expected results on a newborn
D) Erroneous results that should be rejected

Question 8

Which of the following assays is not part of a typical complete blood count?

A) RBC count
B) Mean cell hemoglobin concentration
C) Plasma ferritin
D) Platelet count

Question 9

Which of the following laboratory values would best correlate with moderate polychromasia on a peripheral blood smear?

A) A low RBC count
B) A retic count of 8%
C) Schistocytes on the PB smear
D) A low PLT count

Question 10

How would you differentiate between an acanthocyte and an echinocyte?

A) The variety in length and distribution of the spikes
B) The number of spikes
C) The presence or absence of a fish-mouth central pallor
D) The size of the cell

Question 11

While performing a 100-cell manual WBC differential, the laboratory professional observes Dohle bodies, toxic granulation and vacuoles in many neutrophils. This would suggest:

A) Megaloblastic anemia
B) Acute leukemia
C) Bacterial infection
D) Chronic leukemia

Question 12

Remnants of DNA inside an RBC produce which type of inclusion?

A) Howell-Jolly bodies
B) Basophilic stippling
C) Cabot rings
D) Pappenheimer bodies

Question 13

A peripheral blood smear exhibits heterogeneity in RBC size distribution throughout the smear. Which of the RBC indices would be most indicative of this?

A) MCHC
B) MCV
C) RDW
D) MCH

Question 14

Which of the following is the proper order for reporting a CBC with one or more critical values:

A) Repeat for confirmation, report in LIS with documentation
B) Fax to RN, repeat for confirmation, report in LIS
C) Report in LIS, repeat for confirmation, phone MD
D) Repeat for confirmation, phone MD, report in LIS with documentation

Question 15

Identify the poikilocytes indicated by the arrows in the following image.

A) Acanthocytes
B) Drepanocytes
C) Schizocytes
D) Spherocytes

Question 16

Which RBC parameter describes the average volume of the RBCs in a blood sample?

A) MCV
B) RDW
C) Reticulocyte count
D) MCHC

Question 17

What RBC inclusions cannot be seen with Romanowsky stain but can be visualized with supravital stain?

A) Howell-Jolly bodies
B) Pappenheimer bodies
C) Cabot rings
D) Heinz bodies

Question 18

A patient sample has an RBC count of 4.30 × 10¹²/L and a reticulocyte count of 4%. What is the absolute retic count?

A) 142 × 10⁹/L
B) 172 × 10⁹/L
C) 350 × 10⁹/L
D) 90 × 10⁹/L

Question 19

Acanthocytes or spur cells have membranes with irregular distribution of spikes. What other significant feature does this cell possess?

A) Increased size
B) Presence of Pappenheimer bodies
C) Decreased life span
D) Lack of central pallor

Question 20

The following data were reported by an instrument: RBC = 5.00 × 10¹²/L, hemoglobin = 8.5 g/dL and hematocrit = 32%. Calculate the MCHC.

A) 29.5
B) 26.6
C) 17.0
D) 64.0

Question 21

Which parameter provides the best estimate of bone marrow megakaryocytopoiesis?

A) Mean platelet volume
B) Reticulated platelets
C) Absolute Retic count
D) Platelet distribution width

Question 22

What disease state is associated with helmet cells?

A) Diabetes
B) Iron deficiency
C) Heart valve hemolysis
D) Thalassemia

Question 23

A patient sample arrives in the laboratory with the name on the tube and no other information. What is missing?

Question 24

Calculate the MCV from the results of a patient's CBC: RBC = 3.50 × 10¹²/L
Hemoglobin = 12.0 g/dL
Hematocrit = 40%

A) 30
B) 31
C) 100
D) 114

Question 25

Which of the following test results would indicate a positive bone marrow response to anemia?

A) Retic % decreased
B) Retic absolute increased
C) Retic absolute decreased
D) IPF increased

Question 26

An instrument printout reveals an RDW of 33. Which of the following would best correlate with those results?

A) The presence of a dimorphic cell population on the PB smear
B) The presence of marked polychromasia on the PB smear
C) The presence of spherocytes on the PB smear
D) The presence of macro-ovalocytes on the PB smear

Question 27

Which of the following values would be considered normal in a healthy 1-day old newborn?

A) HGB: 18 g/dl; MCV: 106 fl; Reticulocyte: 4.8%
B) HGB: 23 g/dl; MCV: 88 fl; Reticulocyte: 9.1%
C) HGB: 14 g/dl; MCV: 77 fl; Reticulocyte: 2.2%
D) HGB: 16 g/dl; MCV: 85 fl; Reticulocyte: 0.6%

Question 28

What should be reported about the RBCs indicated by the arrows in the following image?

A) Hypochromasia
B) Drepanocytes
C) Ovalocytes
D) Macrocytes

Question 29

Identify the poikilocytes in the following image and indicate a possible mechanism for their formation.

A) Stomatocytes; liver disease
B) Elliptocytes; iron deficiency
C) Schisocytes; intravascular damage
D) Codocytes; intracellular defect

Question 30

Identify the RBC inclusion in the following image.

A) Siderotic granule
B) Basophilic stippling
C) Howell Jolly body
D) Heinz body

Question 31

Codocytes are associated with all of the following conditions except:

A) Iron-deficiency anemia
B) Thalassemias
C) Hemoglobinopathies
D) Hemolytic anemia

Question 32

Howell-Jolly bodies are red cell inclusions associated with what disease state?

A) Lead poisoning
B) G6PD deficiency
C) Megaloblastic anemia
D) Normal reticulocytes

Question 33

What is one of the disease states associated with the presence of target cells?

A) Sickle cell anemia
B) Thalassemia
C) Uremia
D) Hemolytic anemia

Question 34

Describe the purpose of and the way to calculate the "rule of three."

Question 35

What staining method can be used to differentiate Pappenheimer bodies from reticulocytes?

A) New methylene blue
B) PAS
C) Perl's Prussian blue
D) Phase microscopy on wet prep

Question 36

A CBC shows decreased RBC, HGB, and HCT. The manual reticulocyte count result was 12%. Which of the following would you expect to see on the peripheral smear?

A) Cabot rings
B) Microcytosis
C) Polychromasia
D) Heinz bodies

Question 37

Why do we see Howell-Jolly bodies in patients who have had a splenectomy? Explain your answer.

Question 38

What should be reported about the RBCs in the following image and what affect would this have on the CBC results?

A) agglutination; increased MCV and decreased RBC count
B) rouleaux; no affect on the CBC results
C) codocytes; increased RBC count
D) spherocytes; increased MCV

Question 39

List four pre-examination precautions that must be observed to produce quality results when performing a CBC.

Question 40

An increased red cell distribution width (RDW) usually indicates what abnormality?

A) Increase of average erythrocyte volume
B) Increase of average weight of hemoglobin
C) Decrease in ratio of hemoglobin mass to volume
D) Variation in erythrocyte size