Deck 40: Quality Assessment in the Hematology Laboratory

Question 1

Regarding the evaluation of proficiency testing results, which of the following sets the tolerance limit for a given hematology procedure (e.g., hemoglobin)?

A) The Joint Commission
B) CLIA '88
C) College of American Pathologists
D) COLA

Answer 1

CLIA '88

Question 2

Which of the following statistical measurements can be used to analyze a new instrument's precision?

A)F-test
B)Linear regression
C)Calculated SD
D)T-test

Answer 2

F-test

Question 3

On average, how often should proficiency testing be performed in the laboratory?

A)Once a month
B)Three times a year
C)Once a year
D)Every day

Answer 3

Three times a year

Question 4

The following numbers are on a data set for a new lot of QC material: 23, 25, 19, 27, 20, 22, 24, and 26.What are the mean and standard deviation?

A)27.45; 2.82
B)23.25; 3.15
C)22.47; 1.45
D)23.25; 2.82

Question 5

Quality control is run on the Sysmex XE-2100 for the morning shift.The low control is outside the 2SD limit for the WBC parameter.The technologist investigates the quality control material for low volume, checks reagents, and checks the previous QC charts.There are no discrepancies.What are the technologist's next steps in investigating this finding?

A)Report out the QC results and run patient samples.
B)Notify the supervisor and calibrate the instrument.
C)Notify the company and perform periodic maintenance.
D)Ignore the QC results and run patient samples.

Question 6

In interpreting a patient's CBC results, the clinical laboratory professional notes that the platelet count is 25 x 109/L.Which of the following could be associated with this finding?

A)Observation of RBC fragments on the blood smear
B)Presence of cryoglobulins
C)Observation of platelet clumps at the feather edge of the blood smear
D)Presence of intracellular parasites such as malaria

Question 7

A sample collected for a prothrombin time is delivered to the laboratory 4 hours after collection.Which source of error does this represent?

A) Pre-examination
B) Examination
C) Post-examination Correct

Question 8

Which of the following represents an appropriate step to meet universal precautions?

A) Check the sample source before using protective equipment
B) Require HIV immunization for all healthcare workers
C) Use mechanical pipeting devices to deliver all sample aliquots
D) Dispose of capped needles in biohazard trash bags

Question 9

Implementation of a quality assessment program in laboratories is mandated by:

A)OSHA.
B)JCAHO.
C)CLIA 88.
D)CAP.

Question 10

Improper patient identification is considered a violation of which of the following?

A)Pre-examination QA
B)Examination QA
C)Post-examination QA
D)All of the above

Question 11

The treatment of everything in the laboratory as infectious is defined as:

A)Proficiency testing.
B)Quality control.
C)Reference interval.
D)Universal precautions.

Question 12

Which of the following is an acceptable means for competency testing?

A)Direct observation checklists
B)Random assignment of proficiency samples
C)Blinded pre-analyzed samples
D)All of the above

Question 13

The regulatory body responsible for establishing proper guidelines for biohazardous waste material removal is:

A)OSHA.
B)CAP.
C)JCAHO.
D)MSDS.

Question 14

Who is responsible for training clinical laboratory professionals regarding the use of hazardous chemicals?

A) Human resources department
B) Infection control department
C) Laboratory manager
D) Biotechnology specialist

Question 15

Why is it recommended that only 5-10 subjects be tested per day during a reference interval study?

A) Ensure that all subjects have properly prepared for the blood draw
B) Minimize effect of increased workload on laboratory operations
C) Increase ability to recruit sufficient numbers of subjects
D) Reduce introduction of an instrument or reagent bias

Question 16

A patient's automated reticulocyte count was 203 x 10⁹/L.Which of the following could account for this result?

A) Heinz bodies
B) Platelet satellitism
C) Leukocytosis
D) Fibrin strands

Question 17

Which of the following would cause the technologist to question the specimen integrity of a coagulation blood sample?

A)Hemolysis
B)Blood:anticoagulant ratio < 9:1
C)Blood:anticoagulant ratio > 9:1
D)All of the above

Question 18

The following 20 hemoglobin results were collected for Level I control to determine its initial control limit (Results are in g/dL):
$\begin{array}{lllll}6.2 & 6.5 & 5.4 & 6.0 & 6.4 \\5.8 & 6.0 & 5.9 & 5.7 & 6.1 \\6.1 & 6.1 & 6.6 & 6.2 & 6.4 \\5.7 & 6.2 & 6.3 & 5.9 & 5.8\end{array}$
What are the 2s limits?

A) 5.8-6.4 g/dL
B) 5.8-6.5 g/dL
C) 5.5-6.7 g/dL
D) 5.4-6.7 g/dL

Question 19

Which hematologic parameters would be affected by excessive lipemia in the blood sample?

A)MCV, MCH, MCHC
B)Hgb, MCH, MCHC
C)Hct, MCV, MCHC
D)WBC and differential

Question 20

The purpose of a control material is to:

A) Ensure the reliability of a given test procedure.
B) Determine if a patient result is normal, increased or decreased.
C) Establish the calibration factor for calculation of results.
D) Verify the reportable range for a given test procedure.

Question 21

A clinical laboratory professional performed a procedure to verify the hemoglobin reportable range on the Cell-Dyn 4000.The highest level of linearity check material was 22.0 g/dL.This material was run several times with 21.7 g/dL, representing the mean.How should this finding be interpreted?

A)The result is within the tolerance limits, and the reportable range is verified.
B)The result exceeds the tolerance limits, and the procedure should be repeated with new check material.
C)The result exceeds the tolerance limits, and additional check material should be run in the upper limits of the reportable range.
D)The result exceeds the tolerance limits, and the verification of reportable range should be repeated after the instrument is recalibrated.

Question 22

When using moving averages to monitor an automated hematology instrument, the clinical laboratory professional notes that a moving average falls out of range, but the recently performed quality control was acceptable, what would this indicate?

A) The instrument should be recalibrated.
B) The range is incorrect for the moving average.
C) The patient samples for last 20 results were from a single location.
D) The clinical laboratory professional should open and run new control materials.

Question 23

An instrument printout reveals the following: PT = 9.0 sec and APTT = 20.0 sec.What should the technologist do next?

A)Report patient results.
B)Check the sample for the presence of small clots.
C)Observe the sample for the presence of hemolysis.
D)Examine the collection tube for underfilling.

Question 24

What is the first step in the selection of a new instrument?

A)Conduct a needs assessment survey.
B)Determine the cost per test.
C)Perform an in-house evaluation of the instrument.
D)Evaluate the quality control program offered.

Question 25

What are the components of a method evaluation? Explain the purpose of each.

Question 26

Moving averages can be used to monitor the instrument's performance in determining parameters of which cell line?

A)Leukocyte
B)Erythrocyte
C)Platelets
D)Reticulocytes

Question 27

The following CBC results were obtained on an adult female:
$\begin{array}{ll}\text { RBC } & 3.05 \times 10^{12} / \mathrm{L} &\text { WBC }&8.1 \times 10^{9} / \mathrm{L} \\\mathrm{Hb} & 6.4 \mathrm{~g} / \mathrm{dL} &\text { PLT }& 412 \times 10^{9} / \mathrm{L} \\\mathrm{Hct} & 23 \% \\\mathrm{MCV} & 75 \mathrm{fL} \\\mathrm{MCH} & 21 \mathrm{pg} \\\mathrm{MCHC} & 28 \mathrm{~g} / \mathrm{dL}\end{array}$
Which is the most appropriate action?

A) Report the CBC results to the physician.
B) Repeat the CBC to confirm hemoglobin.
C) Examine peripheral blood smear for giant platelets.
D) Perform saline replacement for plasma and rerun.

Question 28

In reviewing a patient's APTT result, the clinical laboratory professional notes the presence of a delta flag.The patient's current APTT is 54 seconds, while the previous APTT (24 hrs ago) was 31 seconds (Note: QC was acceptable for both runs).Which is the most appropriate action?

A) Report the APTT since QC was acceptable.
B) Check the sample for the presence of clots.
C) Repeat APTT using a different methodology.
D) Perform a mixing study procedure on the sample.

Question 29

What is the goal of the Westgard multirule protocol for evaluating control results?

A) Reject all runs in which 1₂s control rule is violated.
B) Eliminate random error detection.
C) Minimize false rejection of a control run.
D) Increase analytical sensitivity of a control run.

Question 30

What is the importance of documentation in a quality assessment program?

Question 31

Which of the following represents the BEST method to assess a clinical laboratory professional's competency in performing leukocyte differentials?

A) Give the individual a 25-question written examination
B) Observe the individual during performance of a leukocyte differential
C) Assign the individual to complete the next CAP survey for hematology
D) Monitor the number of differentials that require pathology review for this individual

Question 32

An instrument printout reveals a hemoglobin of 15.0 g/dL, an RBC count of 3.0 x 1012/L, and a hematocrit of 30%.The MCHC is 50g/dL.A manual hematocrit is performed, and the technologist observes gross hemolysis and lipemia in the manual hematocrit tube.What is the technologist's next step in correcting the problem?

A)Re-spin the manual hematocrit.
B)Warm the sample and re-run it.
C)Call for a redraw.
D)Perform a plasma replacement.

Question 33

Name one way that the laboratory verifies/validates the following:

A)Accuracy
B)Precision
C)Analytical sensitivity
D)Analytical specificity

Question 34

Identify the critical information that must be on a material safety data sheet.

Question 35

Which of the following Westgard rule violations allows for patient samples to be run?

A)1-3s
B)1-2s
C)R-41s
D)4-1s

Question 36

Given the following fibrinogen control limits: Level I $\quad x=246 \mathrm{mg} / \mathrm{dL} \quad \mathrm{s}=6.0 \mathrm{mg} / \mathrm{dL}$
Level II $\quad \mathrm{x}=75 \mathrm{mg} / \mathrm{dL} \quad \mathrm{s}=2.5 \mathrm{mg} / \mathrm{dL}$
If the multirule control procedure for the fibrinogen assay is 1_3s, 2_2s, and R_4s, how would you interpret the fibrinogen control results for the current run?
$\begin{array}{lccc} \text { Current Run:} & \text { Level I } &232 \mathrm{mg} / \mathrm{dL} \\ & \text { Level II }& 82 \mathrm{mg} / \mathrm{dL}\end{array}$

A) Acceptable
B) Unacceptable, 1?s violation
C) Unacceptable, 2?s violation
D) Unacceptable, R?s violation

Question 37

Which performance study in the method evaluation process determines the reportable range for the test method?

A) Precision study
B) Linearity study
C) Calibration study
D) Method comparison study

Question 38

Patient samples are run on hematology analyzers to assess the instrument's:

A)Accuracy.
B)Precision.
C)Specificity.
D)Sensitivity.

Question 39

Which source of error would be detected by a delta check?

A)Depleted reagent supply
B)Improper calibration of the instrument
C)Deteriorating light source
D)Failure to

Question 40

Given the following precision study results for an automated prothrombin time procedure: $\begin{array}{l}\text { Precision Study }\\\begin{array}{|l|l|l|l|}\hline & \text { Level 1 } & \text { Level 2 } & \text { Level 3 } \\\hline \text { Mean } & 10.5 \mathrm{sec} & 12.1 \mathrm{sec} & 19.4 \mathrm{sec} \\\hline \text { SD } & 0.06 & 0.18 & 0.17 \\\hline \text { CV } & 0.6 \% & 1.5 \% & 0.9 \% \\\hline \text { Manufacturer's } & & & \\ \text { CV } & 0.8 \% & 1.1 \% & 1.1 \% \\\hline\end{array}\end{array}$
Which is the appropriate interpretation?

A) Precision study results are acceptable.No random error was detected.
B) Precision study results are unacceptable.Instrument should be recalibrate and precision study repeated.
C) Precision study results are unacceptable.The sampling pipet should be replaced and precision study repeated.
D) Precision study results are unacceptable.Review results for outliers if present eliminate from data and recalculate CV.

Question 41

Name the hematologic/hemostatic parameters that are affected by hemolysis, and offer a means by which to correct the problem.