Deck 34: Bone Marrow Examination

Question 1

If a bone marrow aspiration results in a dry tap, how are the slides prepared?

A)Touch imprints of the core biopsy
B)Core biopsy washings
C)Re-aspiration
D)Histologic embedded paraffin blocks

Answer 1

Touch imprints of the core biopsy

Question 2

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

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 and benign have an aberrant phenotype.

Answer 2

Benign aggregates are well defined, whereas malignant aggregates are ill-defined.

Question 3

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

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

Answer 3

Femur.

Question 4

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 the diagnosis of aplastic anemia.
C)No, the patient is not suffering from aplastic anemia, because the overall cellularity is increased.
D)Yes, the patient may be suffering from aplastic anemia, due to the low overall cellularity and the normal M:E ratio.

Question 5

The primary location for bone marrow collection is dependent 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 6

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

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

Question 7

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 8

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

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

Question 9

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 10

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 11

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

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

Question 12

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

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

Question 13

All of the following are conditions in which a bone marrow aspirate is indicated EXCEPT:

A)Diagnosing infections of known origin.
B)Staging malignancies.
C)Evaluation of unexplained cytopenia.
D)Primary diagnosis of hematologic malignancies.

Question 14

The Prussian blue stain is used to stain what element?

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

Question 15

What is the role of the hematology technologist in bone marrow evaluation?

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.

Question 16

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 17

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

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 20

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 21

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

A)Normal M:E ratio
B)Increased M:E ratio
C)Decreased M:E ratio
D)No effect on the M:E ratio

Question 22

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

Question 23

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

A)Well defined.
B)Ill defined, and small to large.
C)Diffuse and patchy.
D)Well defined with plasma cells.

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 clinical 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

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

Question 26

What are the main differences in uses between a core biopsy specimen and aspirate specimen?

Question 27

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 28

What is the calculation to determine the normal expected cellularity range in an adult?

A)Subtract the patient's age from 100% and add/subtract 20%.
B)Subtract the patient's age from 100% and add/subtract 10%.
C)Subtract the patient's age from 100% and add/subtract 30%.
D)Subtract the patient's age from 100% and add/subtract 50%.

Question 29

The assays below are typically performed on bone marrow specimens.Match each assay with the appropriate specimen type, assuming both are available.

A)Bone marrow differential
B)M:E ratio
C)Cellularity
D)Assessment of iron stores

Question 30

A normal M:E ratio is about 3:1.Why are there three times more myeloid precursors than erythroid precursors in the bone marrow?

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

Question 31

Which of the following is required information on a bone marrow report?

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)All of the above

Question 32

What are the primary uses of flow cytometry in the evaluation of hematologic disorders?

A)To detect the presence of clonality, and diagnose and classify malignant lymphomas and leukemias
B)Classifying anemias associated with defective hemoglobin synthesis
C)Identifying specific genetic rearrangements
D)To detect chromosomal alterations

Question 33

Compare 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 34

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