Deck 38: Bone Marrow Examination

Question 1

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

A)BM aspirate;patient age
B)BM aspirate;hematogones
C)BM biopsy;yellow marrow
D)BM biopsy;stromal cells

Answer 1

BM biopsy;yellow marrow

Question 2

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

A)Diagnosing infections of known origin
B)Staging malignancies
C)Evaluating unexplained cytopenia
D)Making primary diagnosis of hematologic malignancies

Answer 2

Diagnosing infections of known origin

Question 3

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

A)Perform the bone marrow aspirate procedure
B)Administer anesthetic in preparation of the procedure
C)Make bone marrow smears after collection
D)Report the results of the bone marrow examination to the attending physician

Answer 3

Make bone marrow smears after collection

Question 4

The Prussian blue stain is used to stain what element?

A)Organelle-associated enzymes
B)Carbohydrates
C)Iron
D)Proteins

Question 5

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

A)100
B)2000
C)1000
D)10 of each lineage

Question 6

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

A)Tibia
B)Femur
C)Sternum
D)Iliac crest

Question 7

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

A)Benign aggregates are well defined,whereas malignant aggregates are ill-defined.
B)Malignant aggregates are composed of single polymorphic cells,whereas benign aggregates are composed of multiple monomorphic cells.
C)Benign aggregates are clonal,whereas malignant aggregates are polyclonal.
D)Malignant aggregates have a normal phenotype,whereas benign have an aberrant phenotype.

Question 8

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

A)Iron-laden macrophages
B)Sea blue histiocytes
C)Moderate siderocytes
D)Ringed sideroblasts

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?

A)There is not enough information to determine whether the patient has aplastic anemia.
B)Yes,the patient is presumably suffering from aplastic anemia,but the M:E ratio does not correlate well with that diagnosis.
C)No,the patient is not suffering from aplastic anemia because the overall cellularity is increased.
D)Yes,the patient is presumably suffering from aplastic anemia because of the low overall cellularity and the normal M:E ratio.

Question 10

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

A)Age and patient condition
B)Change in sites of hematopoiesis and cellularity
C)The M:E ratio and medical history
D)Age and medical history

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)?

A)Decreased or absent Prussian blue specks
B)Adequate iron stores with Prussian blue stain
C)Sea blue histiocytes
D)Increased iron stores

Question 12

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

A)Stromal cells to hematopoietic cells
B)Hematogones to hematopoietic cells
C)Adipose tissue to hematopoietic cells
D)Hematopoietic cells to non-hematopoietic cells

Question 13

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

A)35-45%
B)55-75%
C)50-60%
D)70-80%

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

A)Touch imprints of the core biopsy
B)Core biopsy washings
C)Reaspiration of marrow
D)Histologic embedded paraffin blocks

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?

A)2:1
B)24:1
C)12:1
D)15:1

Question 16

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

A)Erythroid hypoplasia
B)Erythroid hyperplasia
C)Myeloid hyperplasia
D)CML

Question 17

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

A)It has higher specificity for hematopoietic lineage differentiation than does standard morphology.
B)It has lower incidence of false negatives in detecting malignancies.
C)Manual differentials are prone to misinterpretation,whereas cytochemical staining is not.
D)It provides a better overview of bone marrow status of hematopoiesis than does the manual differential.

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?

A)The bone marrow has myeloid hyperplasia.
B)The bone marrow has erythroid hyperplasia.
C)The bone marrow is normal.
D)The overall cellularity of the marrow is hypercellular.

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?

A)Superior iliac crest
B)Vertebrae
C)Tibia
D)Sternum

Question 20

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

A)Myeloid precursors and erythroid and lymphoid precursors
B)Myeloid precursors and lymphoid precursors
C)Megakaryocytic precursors and nucleated erythroid precursors
D)All granulocytic precursors and nucleated erythroid precursors

Question 21

Identify Prussian blue iron stain results in the following disorders and explain your answers:
a.Iron-deficiency anemia
b.Anemia of chronic disease
c.Thalassemia
d.Sideroblastic anemia

Question 22

All of the following are required information on a bone marrow report except:

A)Site of sampling and type of sample(s)obtained
B)Side-by-side comparison of bone marrow differential and peripheral blood differential results
C)Results of ancillary studies
D)Final diagnosis by the pathologist

Question 23

The calculation to determine the normal expected cellularity range in an adult is to subtract the patient's age from 100% and:

A)Add/subtract 20%
B)Add/subtract 10%
C)Add/subtract 30%
D)Add/subtract 50%

Question 24

A physician performing a bone marrow biopsy on a patient suspected of having acute leukemia was unable to obtain any aspirate but was able to obtain two core biopsies.What is the best way for the laboratorian to use the material obtained?

A)Place both core biopsies in formalin and process one immediately;save the other for ancillary tests.
B)Place one core biopsy in formalin and freeze the second one at -70°C.
C)Place one core biopsy in formalin after making touch imprints;put the second in saline.
D)Place both core biopsies in saline;freeze one at 0°C,and process the other immediately.

Question 25

The primary uses of flow cytometry in the evaluation of hematologic disorders are to:

A)Detect the presence of clonality and diagnose and classify malignant lymphomas and leukemias
B)Classify anemias associated with defective hemoglobin synthesis
C)Identify specific genetic rearrangements
D)Detect chromosomal alterations

Question 26

Name five distinguishable characteristics that will help differentiate benign lymphoid aggregates and malignant lymphoma.

Question 27

One morphological difference between benign lymphoid aggregates and malignant lymphoma is that malignant aggregates are:

A)Well defined
B)Well defined with mature lymphocytes
C)Diffuse and patchy
D)Well defined with plasma cells

Question 28

Name disorders in which the following should be included in the workup of a hematologic disorder.Explain why they are used.
a.Flow cytometry
b.Cytogenetics
c.Molecular genetics
d.Cytochemical staining

Question 29

A normal M:E ratio is about 3:1.A patient has three times more myeloid precursors than erythroid precursors in the bone marrow because:

A)The body needs more cells to fight infection than to transport oxygen.
B)The life cycle of a WBC is much longer than that of an RBC.
C)WBCs undergo more steps in hematopoiesis than do RBCs.
D)The life cycle of a WBC is much shorter than that of an RBC.

Question 30

Which of the following is not typically found on a bone marrow report?

A)Patient's insurance information
B)Patient's biographical data
C)Patient's clinical diagnosis
D)Relevant therapeutic information

Question 31

What are the main reasons for using a core biopsy specimen versus an aspirate specimen?

Question 32

The following assays are typically performed on bone marrow specimens.Match each assay with the appropriate specimen type,assuming that both are available.
a.Bone marrow differential
b.M:E ratio
c.Cellularity
d.Assessment of iron stores

Question 33

What would be the expected effect of chronic myelogenous leukemia on the M:E ratio?

A)Normal
B)Increased
C)Decreased
D)None

Question 34

What cells are examined for morphologic characteristics of iron particles in the diagnosis of myelodysplastic syndrome?

A)Leukocytes
B)Erythrocytes
C)Histiocytes and red cell precursors
D)Lymphocytes