Hematology I MCQS

November 2019

SECTION A: OBJECTIVE QUESTIONS (20 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. The liquid portion of the blood is referred to as

(A) plasma*

(B) platelet

(D) haematein

2. A common site for haematopoiesis in adults is the

(A) liver

(B) thymus

(D) bone marrow*

3. White blood cells with coarse, strongly basophilic cytoplasmic granules are

(A) basophils*--C blue-black, N dark purplish blue, bi-lobed, S shape

(B) monocytes--C bluish grey, N dark purple/blue, horseshoe shape

(D) neutrophils--multi-lobed, lysosome granules, C pinkish purple, N purple

4. The primary function of anticoagulants is to

(A) make blood lyses faster

(B) dilute blood before testing

(D) prevent the growth of bacteria

5. Which of the following anticoagulants acts by inhibiting thrombin formation?

(A) EDTA--purple, CBC, insoluble Ca salt

(B) heparin*--green

(D) sodium fluoride--grey, precipitate Ca, glucose testing

6. Which of the following red cell indices reflects the amount of haemoglobin per individual red cell?

(A) haemoglobin (Hb)

(B) mean cell volume (MCV)--size, normocytic, microcytic, macrocytic (pg)

(D) mean corpuscular haemoglobin concentration (MCHC)--concentration, normochromic (pinkish red), hypochromic

7. Normal adults haemoglobin is composed of

(A) HbA

(B) HbA and HbA2

(D) HbA, HbA2, HbF and HbH

8. Haem synthesis in the immature erythrocytes occurs largely in the

(A) nuclei

(B) ribosomes

(D) mitochondria*

9. Haemoglobin F structure is consists of which globin chains?

(A) beta (β) and delta (δ)--HbA2

(B) alpha (α) and beta (β)--HbA

(D) alpha (α) and gamma (γ)*--a2g2

10. The following data were obtained from an EDTA-anticoagulated blood: Erythrocyte count = 4.11 x 1012/L; hemoglobin = 12.8 g/dL; hematocrit = 38% (0.38 L/L). Calculate the MCH.

(A) 15.6 pg

(B) 31.1 pg

(D) 92.5 pg

Hemoglobin/RBC count

11. The following data were obtained from an EDTA-anticoagulated blood: Erythrocyte count = 4.05 x 1012/L; hemoglobin = 10.7 g/dL; hematocrit = 37% (0.37 L/L). Calculate the MCV.

(A) 28.9 fL

(B) 34.6 fL

(D) 264.1 fL

Hematocrit/RBC count

12. Which of the following conditions may result in an increased haematocrit value?

(A) hypoxia*--polycythemia, severe dehydration

(B) hemolysis

(D) massive blood loss

13. Which of the following conditions may result in an increased erythrocyte sedimentation rate (ESR) value?

(A) cytosis--spherocytosis (micro) for decreased, macro for increased

(B) polycythaemia

(D) rouleaux formation*--anemia, multiple myeloma, pregnancy, inflammation, menstruation

14. What is the normal packed cell volume (PCV) value in adult male?

(A) 32 – 42%

(B) 37 – 47%--female

(D) 47 – 57%

15. Which of the following blood components react with the acidic dye of Leishman’s stain and results in a bright orange colour?

(A) platelets

(B) erythrocytes

(D) granules of eosinophils*

16. Which of the following diluents is used for manual RBC counts?

(A) 1% formalin.

(B) 3% acetic acid.

(D) 0.85% sodium chloride.*--normal saline

17. The staining method used in determining reticulocytes count is

(A) Leishman’s stain

(B) haematoxylin stain

(D) Brilliant Cresyl blue stain*--methylene blue, Wright/Giemsa

18. What is the most possible condition of a patient with a reticulocyte count of 30 per 500 erythrocytes?

(A) healthy

(B) leukaemia

(D) bone marrow failure

N: 0.5~1.5%

19. Micro-sampling on newborn infants is usually taken from

(A) toe

(B) ear

(D) finger

20. Which of the following statements are TRUE for Romanowsky staining?

I. It is a polychromatic solution

II. It contains eosin and methylene blue dye

III. George Papanicolaou invented this staining technique

IV. Brilliant Cresyl blue gives basophilic colour to the nucleus of the cells

(A) I and II*

(B) I and IV

(D) II, III and IV

SECTION B: TRUE AND FALSE QUESTIONS (10 MARKS)

STATE WHETHER THE FOLLOWING STATEMENTS ARE TRUE (T) OR FALSE (F).

1. About 90% of the plasma is composed of water. T--plasma protein, blood sugar, lipids, inorganic salts, substances, gases

2. The normal range of red blood cells (RBC) count in males is lower than in females. F

3. Decrease in a white blood cell count is called thrombocytopenia. T

4. The most suitable anticoagulant for blood coagulation studies is an EDTA. F--Sodium citrate (light blue)

5. RBC breakdown usually occurs after a mean life span of 60 days. F--120

6. Haemocytometer is a tool used for manual blood cells counting. T

7. Haematocrit and mean cell volume (MCV) are referring to the similar RBC parameter. F

8. Picogram (pg) unit is used to represent the mean cell hemoglobin (MCH) of an erythrocyte. T

9. May-Grunwald and Giemsa stains are the examples of Romanowsky stain. T

10. In normal neonates, the reticulocyte count may be up to 10% of the total RBC. F

SECTION C: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Describe THREE (3) characteristics of hematopoietic stem cell. (6 Marks)

Self-renewal--intrinsic capacity for self-reproduction but are low in number and divide infrequently

Multipotentiality--capacity to generate cells of all the hematopoietic lineages

Differentiation--myeloid or lymphoid lineage, differentiate into 5 major of blood cellular components

b. List FOUR (4) cell stages in monopoiesis. (4 Marks)

Progenitor stem cells

Monoblast

Promonocyte

Monocyte and Macrophage

2. a. State FIVE (5) characteristics of anticoagulants. (5 Marks)

It must not alter the size of the RBCs

It must not cause hemolysis

It must minimize platelet aggregation

It must minimize disruption of the staining and morphology of leukocytes

It must be readily soluble in blood

b. List FIVE (5) disadvantages of heparin as an anticoagulant. (5 Marks)

may cause clumping of leukocytes

interfere with staining of leukocytes

most expensive

blood will clot in 8~12 h

not suitable for agglutination tests, prothrombin time tests, or plasma fibrinogen determination

3. a. Using appropriate diagrams, explain the basic principle of erythrocyte sedimentation rate (ESR). (6 Marks)

rate of settling depends on

plasma protein composition
concentration of erythrocytes
number and size of erythrocytes
certain technical and mechanical factors

=size of falling particles

the larger the particle, the faster it falls

b. Describe the errors that give false-negative results in ESR. (4 Marks)

tube stands less than 1 h

anticoagulated blood more than 2 h old

improper concentration of anticoagulant -whole blood ratio

refrigerated blood or decreased room temp

SECTION D: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

With the aid of diagrams, explain the steps in preparing peripheral blood film (PBF) using Wedge slide technique. Then, describe the characteristics of good PBF smears. (20 Marks)

place a drop of blood in the centre of a clean glass slide 1~2 cm from one end

place spreader slide with smooth edge at an angle of 30~45 near the drop of the blood

move the spreader backward to make contact with the drop of blood

move the spreader forward rapidly over the slide

a thin peripheral blood film is prepared

dry and stain

characteristics:

not cover entire surface of slide
have smooth and even appearance
free from waves and holes
no irregular tail

Question 2

Discuss the mechanical and biological sources of errors in microcapillary measurement of hematocrit value. (20 Marks)

mechanical error:

interval between centrifugation and measurement
centrifugation time too short and speed too low
forcing centrifuge to stop
inadequate mixing
incomplete sealing of the capillary
bubbles in hematocrit

biological error

measurement of buffy coat
clotting of sample
inadequate specimen
inclusion of trapped plasma
hemolysis of sample

September 2018

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Hematology is defined as the study of

(A) blood*

(B) tissues

(D) bacteria and viruses

2. The liquid portion of blood is referred to as

(A) serum

(B) plasma*

(D) whole blood

3. A common site for haematopoiesis in adults is the

(A) liver

(B) thymus

(D) bone marrow*

4. Which of the following is the largest white blood cells?

(A) basophils

(B) monocytes*

(D) neutrophils

5. White blood cells with coarse, strongly basophilic cytoplasmic granules are

(A) basophils*

(B) monocytes

(D) neutrophils

6. A small, agranular leukocyte with dark blue and round nucleus refers to

(A) monocytes

(B) reticulocyte

(D) megakaryocyte

7. The primary function of anticoagulants is to

(A) make blood lyses faster

(B) dilute blood before testing

(D) prevent blood from clotting*

8. Which of the following anticoagulants acts by inhibiting thrombin formation?

(A) EDTA

(B) heparin*

(D) sodium fluoride

9. The anticoagulant of choice for coagulation testing is

(A) EDTA

(B) heparin

(D) sodium fluoride

10. Which of the following red cell indices reflects the amount of hemoglobin per individual red cell?

(A) hemoglobin (Hb)

(B) mean cell volume (MCV)

(D) mean corpuscular hemoglobin concentration (MCHC)

11. Drabkin’s reagent used in cyanmethemoglobin method contains

(A) ferric ion and sodium ion

(B) potassium and ferricyanide

(D) potassium cyanide and potassium ferricyanide*

12. Normal adult haemoglobin consists of

(A) Hb A

(B) Hb A and Hb A2

(D) Hb A, Hb A2, Hb F and Hb H

13. Haem synthesis in immature erythrocytes occurs largely in the

(A) nuclei

(B) ribosomes

(D) mitochondria*--cytosol

14. Hemoglobin F structure consists of which globin chains?

(A) beta (β) and delta (δ)

(B) alpha (α) and beta (β)

(D) alpha (α) and gamma (γ)*

15. Given the patient haematocrit is 42% and the erythrocyte count is 5.3 x 1012/L. The mean cell volume of the patient is

(A) 70.4 fL

(B) 72.6 fL

(D) 82.3 fL

16. Erythrocyte count = 3.92 x 1012/L; hemoglobin = 11.4 g/dL; hematocrit = 34%

The data in Figure 1 were obtained from an EDTA-anticoagulated blood. Calculate the Mean cell hemoglobin (MCH).

(A) 29.1 pg

(B) 33.5 pg

(D) 86.7 pg

17. The following data were obtained from an EDTA-anticoagulated blood: Erythrocyte count = 4.11 x 1012/L; hemoglobin = 12.8 g/dL; hematocrit = 38% (0.38 L/L). Calculate the MCH.

(A) 15.6 pg

(B) 30.6 pg

(D) 92.5 pg

18. The following data were obtained from an EDTA-anticoagulated blood: Erythrocyte count = 4.05 x 1012/L; hemoglobin = 10.7 g/dL; hematocrit = 37% (0.37 L/L). Calculate the MCV.

(A) 28.9 fL

(B) 34.6 fL

(D) 264.1 fL

19. Which of the following conditions may result in an increased hematocrit value?

(A) hypoxia*

(B) hemolysis

(D) massive blood loss

20. Which of the following conditions may result in an increased erythrocyte sedimentation rate (ESR) value?

(A) cytosis

(B) polycythaemia

(D) rouleaux formation*

21. What is the normal packed cell volume (PCV) value in adult male?

(A) 32 – 42%

(B) 37 – 47%

(D) 47 – 57%

22. Which of the following blood components react with acidic dye of Leishman’s stain and results in bright orange color?

(A) platelets

(B) erythrocytes

(D) nucleus of lymphocytes

23. The thin blood film in Figure 2 is too short. This happens when the

(A) drop of blood is too much

(B) angle of spreader is too high*

(D) edge of spreader is pitted or uneven

24. A 1:200 dilution of a patient's sample was made and 336 red cells were counted in an area of 0.2 mm2. What is the RBC count?

(A) 1.68 x 1012/L

(B) 3.36 x 1012/L

(D) 6.16 x 1012/L

336 x 200 x 106/(0.2 x 0.1)

25. Which of the following diluents is used for manual RBC counts?

(A) 1% formalin.

(B) 3% acetic acid.

(D) 0.85% sodium chloride.*

26. Staining method used in determining reticulocytes count is

(A) Leishman’s stain

(B) haematoxylin stain

(D) Brilliant Cresyl blue stain*

27. What is the most possible condition of a patient with reticulocyte count of 30 per 500 erythrocytes?

(A) healthy

(B) leukemia

(D) bone marrow failure

28. Micro-sampling on newborn infants is usually taken from

(A) toe

(B) ear

(D) finger

29. Leukopenia can be described as below, EXCEPT

I. increased number of leukocytes

II. decreased number of leukocytes

III. decreased concentration of leukocytes in peripheral blood

IV. increased number of neutrophils, eosinophil and basophils

(A) I and IV*

(B) II and III

(D) II, III and IV

30. Which of the following statements are TRUE for Romanowsky staining?

I. It is a polychromatic solution

II. It contains eosin and methylene blue dye

III. George Papanicolaou invented this staining technique

IV. Brilliant Cresyl blue gives basophilic colour to the nucleus of the cells

(A) I and II*

(B) I and IV

(D) II, III and IV

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Describe THREE (3) characteristics of hematopoietic stem cell. (6 Marks)

Self renewal, intrinsic capacity

Multipotentiality, generate

Differentiation, myeloid or lymphoid lineage

b. List FOUR (4) cell stages in monopoiesis. (4 Marks)

2. a. State FIVE (5) characteristics that anticoagulants should have. (5 Marks)

b. List FIVE (5) disadvantages of heparin as anticoagulants. (5 Marks)

leukocytes clumping

expensive

interfere with staining of leukocytes

not suit for agglutination test

blood clot in 8~12 h

3. a. Using appropriate diagram, explain the basic principle of erythrocyte sedimentation rate (ESR). (6 Marks)

b. Describe the errors that give false negative results in ESR. (4 Marks)

decreased room temp

improper concentration of anticoagulant

tube stands <1 h

anticoagulated blood >2 hours old

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

With aid of diagrams, explain the steps in preparing peripheral blood film (PBF) using Push-Wedge method. Then, describe the characteristics of good PBF smears. (20 Marks)

Question 2

With the aid of a diagram, explain the process of haemoglobin synthesis. (20 Marks)

65% of Hb is synthesized in erythroblasts, 35% at reticulocyte stage

haem synthesis in mitochondria of immature RBC

globin synthesis in polyribosomes in cytosol of immature RBC

Hb molecule is a tetramer consists of 4 polypeptide chains (globin): 2 alpha each 141 amino acids long; 2 beta each 146 amino acids long

there are 8 functional globin coded by 2 clusters of genes

expressed under genetic control

a and z globin genes cluster on short arm of chromosome 16

b, d, d and e on short arm of chromosome 11

globin synthesis is first detected in the primitive erythroid precursors of yolk sac at about 3 w of gestation

embryonic: Gower I (z2e2), Portland (z2g2), Gower II (a2e2)

fetal: HbF (a2g2), HbA (a2b2)

normal adult blood not just contains HbA, also contains small quantities of HbF (a2g2) and HbA2 (a2d2)

major switch from fetal to adult Hb occurs after 3~6 m of birth

haem synthesis starts with condensation of glycine and succinyl CoA to form d-aminolevulinic acid synthase enzyme (d-ALA)

V B6 is the coenzyme

2 molecules of d-ALA condense to form porphobilinogen (PBG)

4 PBG condense to form uroporphyrinogen III

UPG III converted to coproporphyrinogen

CPG changes too protoporphyrin which ultimately combines with iron in ferrous state to form haem

iron is brought to the developing RBCs by a carrier protein (transferrin) which attaches to special binding sites on the surface of cells

transferrin releases iron and returns back to circulation

each molecule of haem combines with a globin chain

a tetramer of 4 globin chains, each with its own haem group is formed to make up a Hb molecule

Question 3

Discuss the mechanical and biological sources of errors in microcapillary measurement of hematocrit value. (20 Marks)

February 2018

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. __________ are important in the transport of oxygen and carbon dioxide between the lungs and body tissue.

(A) Plasma

(B) Leukocytes

(D) Thrombocyte

2. Fifty-five percent (55%) of the human blood is composed of

(A) plasma*

(B) platelets

(D) white blood cell

3. A common site of haematopoiesis in adult is the

(A) liver

(B) thymus

(D) bone marrow*

4. The five types of leukocytes found in normal peripheral blood are

(A) lymphocytes, monocytes, thrombocytes, basophils, eosinophils

(B) lymphocytes, neutrophils, monocytes, eosinophils and basophils*

(D) lymphocytes, neutrophils, monocytes, myeloblasts and eosinophils

5. Which flow is TRUE for haematopoiesis?

(A) differentiation formation development

(B) formation development differentiation*

(D) formation differentiation development

6. The precursor of the platelet is

(A) megablast

(B) myeloblast--granulocyte

(D) megakaryocyte*

7. Red blood cell (RBC) production is initiated by the hormone

(A) luteinizing

(B) parathyroid

(D) interstitial cell stimulating

8. The smallest percentage (%) of normal cells in a differential count is

(A) basophils*

(B) monocytes

(D) metamyelocytes

9. The primary function of basophils is to

(A) protect the host from helminth parasites

(B) protect the host from hypersensitivity reaction*

(D) secrete cytokines to attract lymphocytes to the site of infection

10. Lymphocytes can be differentiated from monocytes because lymphocytes have a

(A) large variation in size

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low nucleus cytoplasm (N:C) ratio with intense basophilia on the cytoplasmic edges

11. The anticoagulant most often used for red cell counting is

(A) heparin

(B) sodium citrate

(D) ethylenediaminetetraacetic acid (EDTA)*

12. Which of the following is the example for Romanowsky stain?

(A) eosin stain

(B) carnoy stain

(D) hematoxylin stain

13. Romanowsky stain will macroscopically give

(A) purple red colour

(B) purple blue colour*

(D) purple yellow colour

14. Staining used in determining the reticulocyte count is

(A) Leishman stain

(B) hematoxylin stain

(D) brilliant cresyl blue stain*

15. Normal adult haemoglobin consists of

(A) Hb A

(B) Hb A and Hb A2

(D) Hb A, Hb A2, Hb F and Hb H

16. The polypeptide chains of haemoglobin A are composed of

(A) 2 alpha

(B) 1 alpha, 3 beta

(D) 1 alpha, 2 beta, 1 delta

17. In the breakdown of red blood cells, bilirubin is

(A) excreted*

(B) returned to the pool

(D) reused by new red cells

18. What property of the normal erythrocytes membrane allows the 7 µM cell to squeeze through 3 µM fenestration in the spleen?

(A) fluidity

(B) elasticity

(D) transformability

19. Which of the following is CORRECT molecular structure of the haemoglobin?

(A) two haem group, two irons, two globin chain

(B) four haem group, two irons, two globin chain

(D) four haem group, four irons, four globin chain*

20. Microsampling on a newborn infant is usually taken from

(A) toe

(B) ear

(D) finger

21. Venipuncture is usually performed on the

(A) basilic

(B) cephalic

(D) median antibrachial

22. The simplest method for detecting increased RBC production is

(A) ferrokinetics studies

(B) bone marrow biopsy

(D) measure of the RBC survival

23. The main function of the platelet is to

(A) carry oxygen

(B) fight infection

(D) antibody formation

24. The normal number of thrombocytes per µL is

(A) 5,000 – 10,000

(B) 125,000 – 150,000

(D) 500,00 – 1,000,000

25. The angle used for preparing blood smears is

(A) 5 – 10 degrees

(B) 10 – 20 degrees

(D) 30 – 40 degrees*

26. Which of the following red cell indices reflects the amount of haemoglobin per individual red cell?

(A) haemoglobin (Hgb)

(B) mean corpuscular volume (MCV)

(D) mean corpuscular haemoglobin concentration (MCHC)

27. Each of the following samples may be used in haematology EXCEPT:

(A) EDTA whole blood

(B) serum from clot tube

(D) heparinized capillary blood*--chemistry

28. Which of the following is NOT a characteristic of platelets?

(A) size of 2 to 4 µm--1.5~3

(B) the presence of a nucleus*

(D) cytoplasm a light blue with red-purple granules

29. Which of the following statement is FALSE for erythrocyte sedimentation rate?

(A) It can be done with Wintrobe and Westergren method.

(B) It can be done for more than 1 hour provided the tube is maintained vertical.*

(D) It can produce rouleaux formation of red blood cells in pathological conditions.

30. Which of the following can cause poor blood smear?

I. Holding the pusher slide at 15 degrees

II. a drop of blood that is too large or too small

III. prolonged storage of specimens in EDTA, and dirty slides

IV. delay in preparing the smear once the drop of blood has been placed on the slide

(A) I, II, III*

(B) III, I, IV

(D) I, II, III, IV

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define heme and globins. (2 Marks)

heme: precursor to hemoglobin

globins: heme-containing protein

b. Write FIVE (5) biochemical components needed for heme synthesis. (5 Marks)

glycine, succinyl CoA

dALA

Vitamin B6

porphobilinogen PBG

uroporphyrinogen III UPG

coproporphyrinogen CPG

iron

transferrin

c. List THREE (3) results of hemoglobins degradation. (3 Marks)

iron for recirculation via plasma transferrin to marrow erythroblasts

protoporphyrin which is broken down to bilirubin

globind which are converted to amino acids

2. a. State the principle for erythrocyte sedimentation rate (ESR)? (2 Marks)

settling, size

larger the particle, faster it falls

b. Briefly explain procedures of Westegren method. (4 Marks)

thoroughly mix the blood sample

fill Westegren tube to marked 0 (top)

place tube in Westegren rack

leave for 1 h at room temp

read the upper level of RBCs exactly after 1 h

c. Enumerate the reference value of ESR for:

i. Male below 50 years old (1 Mark)

0~15 mm/h

ii. Female below 50 years old (1 Mark)

0~20

iii. Male over 50 years old (1 Mark)

0~20

iv. Female over 50 years old (1 Mark)

0~30

3. a. Define reticulocytes. (2 Marks)

immature RBC

b. Name the stain used for reticulocyte count. (2 Marks)

Leishman

Giemsa

c. Recall the normal value for adult and newborn reticulocyte count. (2 Marks)

male: 4.5~6.5 x 10 12 /L

female: 3.8~5.8

infant: 4~6

d. State TWO (2) possible sources of error may encounter in reticulocyte count. (4 Marks)

false increase: incubation >15 min, RBC inclusions be mistaken for reticulocyte (Howell-Jolly bodies, Heinz bodies)

false decrease: under stain blood with new methylene blue, stain/blood mixture incubates full 10 min

increased reticulocyte count: effective erythropoiesis, hemolytic anemia, post hemorrhage after 3~4 d

decreased reticulocyte count: ineffective erythropoiesis, aplastic anemia, pernicious anemia

increased RBC: polycythemia, malignancy

decreased RBC: anemia, iron deficiency, blood loss

increased WBC: leokocytosis, ulcer, leukemia

decreased WBC: leucopenia, malaria, hepatitis

increased platelets : thrombocytosis, hemolytic anemia, reactive/benign etiologies

decreased platelets: thrombocytopenia, petechiae, purpura

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

With the aid of diagram, explain in details the differences between granulocytes and agranulocytes. (20 Marks)

granulocyte--granular cytoplasm/cytoplasmic granules, polymorphonuclear, originated from red bone marrow, 65%, multilobe N, innate

agranulocyte--agranular, mononuclear, lymphoid or myeloid tissues, 35%, single lobe N, adaptive

Question 2

Explain how red blood cell count are carried out manually in the laboratories. (20 Marks)

hemocytometer

Neubaeur

EDTA anticoagulated blood is diluted with normal saline (0.85% sodium chloride)

dispose few drops of diluted blood into counting chamber

allow it to settle down for a min

observe under microscope

use power 10x then switch to 40x

count the RBC in the central square, 4 corners and the middle (80 squares)

count RBC touching top or right

logical count

absolute count

quick count

total RBC count=total no of RBC x 200 dilution factor x 10^6 /volume (area x depth)

high RBC count: polycythemia, bone marrow disorder, malignancy

low RBC count: anemia, excessive blood loss or blood destruction, bone marrow failure, iron deficiency

male: 4.5~6.5 x 10^12/L

female: 3.8~5.8

infant: 4~6

Question 3

Create a laboratory Standard Operating Procedure (SOP) for venipuncture technique in blood collection. (20 Marks)

prepare materials and equipment

identify and prepare the patient

introduce yourself

explain procedure and purpose

assess patient's physical disposition

position patient in supine portion

place a clean paper or towel under patient's arm

check requisition form for requested test, patient's info, requirements

select collection site

apply tourniquet about 4~5 finger widths above venipuncture site and re-examine vein

perform hand hygiene

disinfect venipuncture site with 70% alcohol wipes and allow to dry

anchor vein by holding patient's arm and placing a thumb below venipuncture site

ask patient to form a fist

enter vein at 30 degree angle

insert needle bevel-up

tube fills, release tourniquet

apply cotton wool ball in place with arm extended and raised

not to bend arm, cause hematoma

collect sample in appropriate container

fill tubes, keep in rack

invert the sample, mix with additives

discard used needle and syringe

label according form

check label and form

inform patient procedure over

check insertion site

clean up spills

remove gloves (general waste)

perform hand hygiene

send specimen to lab

September 2017

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. What is the percentage of blood plasma in normal blood?

(A) 22%

(B) 45%

(D) 80%

2. Thrombocytes is also known as

(A) platelet*

(B) stem cell

(D) white blood cell

3. What is the diameter of a thrombocytes in µm?

(A) 1 – 3*

(B) 3 – 6

(D) 8 – 10

4. Primary role of white blood cells?

(A) transporting oxygen

(B) producing hemoglobin

(D) maintaining homeostasis

5. Which of the following white blood cells is capable of phagocytosis?

(A) basophil

(B) neutrophil*

(D) lymphocyte

6. Lymphoid stem cell able to produce

(A) platelets

(B) plasma cell*

(D) red blood cell

7. What is the diameter of a neutrophil in µm?

(A) 8 – 10

(B) 12 – 14*

(D) 18 – 20

8. The reticulocyte count is an expression of

(A) red cell production*

(B) red cell in suspension

(D) red cell hemoglobin concentration

9. The hematocrit represents the

(A) packed cell volume*

(B) amount of red blood cells in 1 ml of blood

(D) amount of red blood cells divided by the hemoglobin

10. The protein responsible for the transport of iron in hemoglobin synthesis is

(A) globin

(B) ferritin

(D) transcolamin II

11. Iron is stored in the body in the form of

(A) hemosiderin and ferritin*

(B) apoferritin and transferrin

(D) macrophages and hemoglobin

12. Which of the following is associated with the presence of ribonucleic acid (RNA)?

(A) reticulocytes

(B) thrombocytes

(D) pappenheimer bodies

13. The normal percentage range of neutrophil distribution in adult male is

(A) < 1%--basophil

(B) 2 – 8%

(D) 50 – 70%*

14. Which of the following statements about erythrocytes is CORRECT?

(A) they clot blood

(B) they fight infection

(D) they are produced in the spleen

15. Heme synthesis in immature RBC occurs largely in the

(A) nuclei

(B) ribosomes

(D) mitochondria*

16. What would happen to red blood cells if the heme group were removed from hemoglobin?

(A) Blood clot formation would be inhibited.

(B) Red blood cells would bot be able to reproduce.

(D) Red blood cells would not be able to bind oxygen.*

17. The distribution of normal hemoglobin (Hb) in adults is

(A) 85 – 90% Hb A, 3 – 7% Hb A2, 2 – 3% Hb F

(B) 80 – 90% Hb A, 5 – 10% Hb A2, 1 – 5% Hb F

(D) 96 – 98% Hb A, 1.5 – 3.2% Hb A2, 0.5 – 0.8% Hb F*

22. Determination of relative size of red blood cell 82-98 fl, indicate

(A) packed cell volume (PCV)

(B) mean corpuscular volume (MCV)*

(D) mean corpuscular hemoglobin concentration (MCHC)

23. Recommended needle position for venipuncture with surface of the arm is

(A) 45 degree

(B) < 10 degree

(D) 15 – 30 degree*

24. Which of the following statement indicate the proper blood’s microcollection site of choice?

(A) Toe prick is the best choice for adult.

(B) Heel puncture is the best site for neonates.*

(D) Earlobe is a puncture site for both adult and infants.

25. The normal number of reticulocyte count in an adult does NOT exceed

(A) 0.5%

(B) 1.0%

(D) 2.0%

26. The depth of the area encountered on the hemocytometer for counting cell is

(A) 0.1 mm*

(B) 1.0 mm

(D) 0.04 mm

27. The following are Romanowsky’s stains EXCEPT:

(A) geimsa stain

(B) leishman stain

(D) may-Grunwald Giemsa stain

28. The ratio of blood towards 3.8% sodium citrate in erythrocyte sedimentation rate (ESR) is

(A) 1:1

(B) 1:4*

(D) 1:9

29. The result of erythrocyte sedimentation rate (ESR) test can be influenced by the following factors, EXCEPT

(A) fibrinogen level

(B) rouleaux formation

(D) ratio of blood to anticoagulant

30.

• 10% dilution of blood

• used for platelet aggregation studies

• blood volume less than 90% fill will falsely elevate a PTT result

Which of the following anticoagulant is the MOST suitable with the criteria in Figure 5.

(A) heparin

(B) warfarin

(D) sodium fluoride

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. Write the definition, formulas and reference range for these red blood cell indices:

i. Mean cell volume (3 Marks)

average volume or size

PCV (L/L) /RBC count (x 10 12/L)

male: 80~98

female: 96~108

ii. Mean cell hemoglobin (3 Marks)

weight

Hemoglobin (g/L)/RBC count

27~32 pg

iii. Mean cell hemoglobin concentration (3 Marks)

concentration of hemoglobin

Hemoglobin/PCV

32~36%

2. a. Define hematoma and state the cause. (2 Marks)

bruise

abnormal collection of blood outside of a blood vessel due to damaging vessel wall, artery, vein or capillary

b. Identify the routine site and TWO (2) alternate sites for venipuncture. (3 Marks)

median cubital

cephalic

basilic

c. List in chronological order, the correct steps in the proper performance of a venipuncture using needle and syringe blood collection system. (6 Marks)

3. a. Describe the principle of hematocrit. (4 Marks)

decrease in size or no RBC, decrease amount they occupy, low hematocrit

b. Explain the steps for Westergren method carry out in the laboratory. (6 Marks)

mix anticoagulant

fill tube to marked 0 (top)

vertical 1 h

read upper level

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

With the aid of diagram, explain the hemoglobin synthesis. (20 Marks)

Question 2

Explain how red blood cell count are carried out manually in the laboratories. (20 Marks)

Question 3

With the help of a flow chart, describe the process of hematopoiesis for all cells line in bone marrow. (20 Marks

January 2017

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. The main site of hematopoiesis in the fetus from the second month to the seventh month is the

(A) liver*

(B) kidney

(D) bone marrow

2. Life span of the erythrocyte is

(A) 4 weeks

(B) 6 weeks

(D) 6 months

3. What is the diameter of a normal mature red blood cell in µm?

(A) 2 – 4

(B) 6 – 8*

(D) 14 – 18

4. Anisopoikilocytosis indicates a change in erythrocytes in terms of

(A) size

(B) color

(D) size and shape*

5. The hormone responsible for stimulating the production of platelets is

(A) tyrosine

(B) gonadotropin

(D) thrombopoietin*

6. Primary role of platelet is to

(A) phagocytosis

(B) stop bleeding*

(D) carry carbon dioxide away from the tissue

7. Majority of the white blood cells are made up of

(A) neutrophil*

(B) eosinophil

(D) lymphocyte

8. The normal percentage range of basophil distribution in adult female is

(A) < 1%*

(B) 2 – 8%

(D) 50 – 70%

9. Normal adult hemoglobin consists of

(A) Hb A

(B) Hb A and Hb A2

(D) Hb A, Hb A2, Hb F and Hb H

10. The packed cell volume is also known as the

(A) red blood cell count

(B) hematocrit estimation*

(D) mean cell volume estimation

11. Red blood cells that appear like stacks of coins are referred to as

(A) clumps

(B) rouleaux*

(D) agglutinate

12. The organ that destroys blood cells includes the

(A) liver

(B) spleen*

(D) lymph nodes

13. Erythropoietin a hormone that is required for the normal production of red blood cells is secreted by the

(A) liver

(B) brain

(D) bone marrow

14. The normal range for hemoglobin value of an adult male is

(A) 2 – 6 g/100mL

(B) 8 – 13 g/100mL

(D) 15 – 20 g/100mL

15. The globin chains that are usually present during embryonic development are

(A) zeta and delta

(B) alpha and beta

(D) gamma and alpha

16. The hemoglobin molecule consists of

(A) one heme molecule and one globin chain

(B) one heme molecule and four globin chains

(D) four heme molecules and four globin chains*

17. A dye used for the staining of reticulocytes is

(A) basic fuchsin

(B) gentian violet

(D) sodium nitroprusside

22. Mean cell volume is calculated using the following formula:

(A) (Hg / RBC) x 10

(B) (Hct / RBC) x 10*

(D) (Hct / RBC) x 100

23. Macrocytic of red blood cells is reflected by

(A) increased MCV*

(B) increased MCH

(D) decreased MCH

24. The reticulocyte count is an expression of red blood cells

(A) production*

(B) in suspension

(D) hemoglobin concentration

25. Mixing fresh blood with an anticoagulant will cause all of the following effects EXCEPT

(A) inhibition of coagulation

(B) preservation of calcium iron

(D) preservation of blood cell morphology

26. Which of the following is the formation of blood clot?

(A) coagulation*

(B) chemotaxis

(D) erythropoiesis

27. The normal number of reticulocyte count in an adult does NOT exceed

(A) 0.5

(B) 1.0

(D) 2.0

28. How long can the tourniquets remain on the arm during the venipuncture?

(A) 1 minute*

(B) 2 minutes

(D) 5 minutes

29. All of the following factors may influence the erythrocyte sedimentation rate (ESR), EXCEPT

(A) plasma proteins

(B) caliber of the tube

(D) blood drawn into a sodium citrate tube*

Figure 7

• Mean cell volume : 88 fL 80~98, 96~108

• Mean cell hemoglobin : 30pg 27~32

• Mean cell hemoglobin concentration: 34% 32~36

30. Figure 7 RBC on peripheral blood smear would appear

(A) Microcytic, Hypochromic

(B) Normocytic, Hypochromic

(D) Normocytic, normochromic*

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define heme and globin. (2 Marks)

b. List the requirements for a normal hemoglobin synthesis. (3 Marks)

c. With the aid of a diagram, explain briefly the process of hemoglobin synthesis. (5 Marks)

2. Write the definition, formulas and reference range for these red blood cell indices:

i. Mean cell volume (3 Marks)

ii. Mean cell hemoglobin (3 Marks)

iii. Mean cell hemoglobin concentration (3 Marks)

3. a. Define anticoagulant. (1 Marks)

additive substance, prevent clotting

b. Bullet point FIVE (5) criteria of anticoagulant used in hematology laboratory. (5 Marks)

not alter size RBC

not cause hemolysis

readily soluble in blood

minimize platelet aggregation

minimize staining disruption and morphology of leukocytes

c. Describe the mode of action for sodium citrate as an anticoagulant. (5 Marks)

+Ca=insoluble salt of calcium citrate

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Develop a laboratory Standard Operating Procedure (SOP) for neonate capillary puncture technique. (20 Marks)

Question 2

Explain in details the differences between granulocytes and agranulocytes. (20 Marks)

Question 3

With an aid of diagram, write the method of hematocrit and summarize the sources of errors in a micro-capillary measurement of hematocrit value. (20 Marks)

August 2016

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Life span of thrombocyte is

(A) 10 days*

(B) 30 days

(D) 120 days

2. Leukocyte is also knowns as

(A) platelet

(B) stem cell

(D) white blood cell*

3. Which of the following statement is TRUE regarding normal adult bone marrow?

(A) it secretes erythropoietin

(B) it presents in adults in the skull*

(D) it is composed of 90% haemopoietic cells, 10% fat

4. The best source of active bone marrow from a 20-year old male and female would be

(A) tibia

(B) femur

(D) distal radius

5. The normal percentage range of lymphocyte distribution in adult male is

(A) < 1%

(B) 2 – 8%

(D) 50 – 70%

6. Which of the following samples may be used in hematological test?

(A) buccal swab

(B) EDTA serous fluid*

(D) heparinized capillary blood

7. Which of the following cells are normally present in a normal blood specimen?

(A) erythrocyte, reticulocytes, blasts cell, monocytes, eosinophil, and basophil

(B) erythrocyte, thrombocyte, lymphocytes, neutrophils, blasts and monocytes

(D) erythrocyte, thrombocyte, lymphocytes, neutrophils, monocytes, eosinophil, basophil, few bands and a few polychromatopilic erythrocyte*

8. Which of the following parameters are directly measured on the cell counter?

(A) white blood cell (WBC)*

(B) mean corpuscular volume (MCV)

(D) mean corpuscular hemoglobin concentration (MCHC)

9. What phagocytic cells produce lysozymes that are bactericidal?

(A) platelets

(B) neutrophils*

(D) lymphocytes

10. What staining method is used most frequently to stain and count reticulocytes?

(A) supravital staining

(B) immunofluorescence

(D) cytochemical staining

11. Which of the following is considered normal hemoglobin?

(A) sulfhemoglobin

(B) methemoglobin

(D) carboxyhemoglobin

12. Which of these cytokines has an important role in normal early haemopoiesis?

(A) IL-1, 2, 3, 5, 7 --lympho

(B) IL-2

(D) IL-4

6--mono

13. Green tubes contain additives

(A) heparin, citrate and lithium heparin

(B) sodium heparin, ammonium and silica heparin

(D) sodium heparin, lithium heparin and ammonium ion*

14. The precursor of the platelet is

(A) megablast

(B) meyloblast

(D) megakaryocyte*

15. What color tube contains an antiglycolytic agent?

(A) grey*

(B) green

(D) light blue

16. Prothrombin time and activated partial thromboplastin time tests are drawn from

(A) EDTA tube

(B) heparin tube*

(D) sodium fluoride tube

17. Which way should the beveled needle be facing when entering in the arm?

(A) upwards*

(B) sideways

(D) 90 degree angle

18. Which of the following formula is used to calculate mean cell volume (MCV)?

(A) (hematocrit / hemoglobin) x 100

(B) (hematocrit / red blood cell) x 10*

(D) (hemoglobin / red blood cell) x 100

23. “to measures the average volume/size of an erythrocyte”

Statement in Figure 5 refers to

(A) hematocrit

(B) hemoglobin

(D) mean corpuscular hemoglobin concentration (MCHC)

24. Red cell indices that reflect the amount of hemoglobin per individual red cell is known as

(A) hemoglobin

(B) mean corpuscular volume (MCV)

(D) mean corpuscular hemoglobin concentration (MCHC)

25. What is the major metabolically available storage form of iron in the body?

(A) ferritin

(B) transferrin*

(D) hemosiderin

26. Which ONE of these is NOT TRUE concerning the haemopoietic stem cell?

(A) it is thought to have a CD34+ CD38- phenotype

(B) it resembles a small to medium sized lymphocyte

(D) it is believed to represent approximately 1% of bone marrow cells*

27. Which of the following is NOT a significant component of bone marrow stroma?

(A) fibroblasts

(B) adipocytes

(D) endothelial cells

28. A falsely increased erythrocyte sedimentation rate (ESR) result could be caused by

(A) having too much anticoagulant in the sample tube

(B) having the ESR rack not level (i.e. tubes are tilted)

(D) setting up the ESR while the sample is still cold from the refrigerator

29. Following statement is mechanism by which granulocyte colony-stimulating factor (G-CSF) can increase neutrophil production, EXCEPT

(A) suppression of apoptosis of myeloid cells

(B) increased differentiation from progenitor cells

(D) reduction in the self-renewal of haemopoietic stem cells*

Figure 7

• Red blood cell : 3.72 . 1012/L

• Hemoglobin : 120 g/L

• Hematocrit : 0.36

30. Figure 7 shows RBC indices that would be

(A) MCV = 96, MCH = 29, MCHC = 320

(B) MCV = 97, MCH = 32, MCHC = 333

(D) MCV = 105, MCH = 28, MCHC = 310

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Define hematocrit. (2 Marks)

PCV

proportion of % of blood volume that is occupied by RBC

b. State normal range of hematocrit for adult female and male . (2 Marks)

male: 42~52% (37)

female: 37~47% (42)

c. Give THREE (3) factors that can increase hematocrit reading. (3 Marks)

polycythemia

severe dehydration

hypoxia

d. Name THREE (3) conditions that can decrease hematocrit reading. (3 Marks)

anemia

massive blood loss

hemolysis

menstruation

2. a. Define reticulocytes. (2 Marks)

b. Name the stain used for reticulocyte count. (2 Marks)

c. Recall the normal value for adult and newborn reticulocyte count. (2 Marks)

adult: 0.5~1.5%

newborn: 2.5~6.5%

d. State TWO (2) possible sources of error may encounter in reticulocyte count. (4 Marks)

3. a. State the sources of blood for peripheral blood film. (2 Marks)

venipuncture

b. Describe the principle of romanowsky staining. (4 Marks)

methylene blue, basic dye, acidic affinity, nucleus

eosin

universal

combine fixation and staining

c. Bullet point the colour of any FOUR (4) white blood cell under microscope. (4 Marks)

basophils*--C blue-black, N dark purplish blue, bi-lobed, S shape

monocytes--C bluish grey, N dark purple/blue, horseshoe shape

eosinophils-C bright orange-pink, N purple, bi-lobed

neutrophils--multi-lobed, lysosome granules, C pinkish purple, N purple

lymphocytes--C sky blue, N dark blue, round

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Develop a laboratory Standard Operating Procedure (SOP) for venipuncture technique in blood collection. (20 Marks)

Question 2

With aid of diagrams, write the hemoglobin synthesis. (20 Marks)

Question 3

Create the procedure for red blood cell (RBC) counting using Neubauer chamber count. (20 Marks)

January 2016

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. What is the site of hematopoiesis in embryo?

(A) liver

(B) spleen

(D) bone marrow

2. Hematopoiesis in bone marrow starts at which period of fetal development?

(A) 1st to 2nd weeks

(B) 2nd to 3rd weeks

(D) 6th to 7th months

3. The dominant site of hematopoiesis during 2nd to 7th month of intrauterine life is

(A) liver*--spleen

(B) sternum

(D) bone marow

4. Which of the following gives the colour to red blood cells?

(A) oxygen

(B) buffy coat

(D) carbon dioxide

5. The stains used for demonstration of reticulocytes is

(A) gram stain

(B) ziehl-neelsen stain

(C) new methylene blue*--supravital stain, brilliant cresyl blue, precipitate RNA and organelles, form filamentous network of reticulum

(D) haematoxylin and eosin

6. Normal adult hemoglobin is

(A) Hgb A*

(B) Hgb F

(D) Hgb Portland

7. Which of the following statements about thrombocyte is CORRECT?

(A) they clot blood*

(B) they have nucleus

(D) they are produced in the spleen

8. Which of the following white blood cells increase during hypersensitivity reaction?

(A) basophil

(B) neutrophil

(D) lymphocyte

9. Erythropoiesis, is triggered by the hormone erythropoietin, which is produced by the

(A) liver

(B) brain

(D) bone marrow

10. At what point during the blood collection process should a specimen be labeled?

(A) prior to the procedure

(B) after you have left the patient

(D) after you have finished the procedure, at the patient’s side*

11. What is the preferred site for venipuncture?

(A) wrist vein

(B) femoral artery

(D) median cubital vein*

12. Which type of specimen cannot be collected by capillary puncture?

(A) serology

(B) chemistry

(D) blood culture*

13. Peripheral blood film requires a ____________ top specimen.

(A) black

(B) yellow

(D) light blue

14. The angle of entry for a venipuncture is

(A) 3 – 10 degrees

(B) 10 – 15 degrees

(D) 30 – 45 degrees

15. When collecting blood from a patient with a mastectomy, you should

(A) collect the specimen from patient foot

(B) never collect blood from a patient who has had a mastectomy

(D) not collect blood on the side on which the mastectomy was performed*

16. The normal range for hemoglobin concentration of adult male includes

(A) 6.6 g/dL

(B) 8.0 g/dL

(D) 18.5 g/dL

17. Which of the following is a normal hematocrit value for adult females?

(A) 32%

(B) 38%

(D) 48%

18. Polycythemia vera, a disorder of the bone marrow would cause the hematocrit to be

(A) absent

(B) normal

(D) decreased

23. The clumping together of red blood cells is referred to as

(A) anoxia

(B) erythemia

(D) agglutination*

24. The MOST common white blood cell seen on a white blood cell differential count is

(A) basophil--<1%

(B) monocyte--2~8%

(D) lymphocyte--25~40%

25. Blood smears can be made from venous blood collected with which of the following anticoagulant?

(A) heparin

(B) sodium fluoride

(D) ethylene di-amine tetra acetic acid*

26. The hemoglobin and hematocrit are needed to calculate which of the following indices?

(A) packed cell volume--hematocrit

(B) mean corpuscular volume--Hematocrit/RBC count

(D) mean corpuscular hemoglobin concentration*--Hb/Hematocrit

27. The stain specific for blood smears and used most often in the laboratory is

(A) gram stain

(B) Giemsa stain

(D) May-Grunwald stain

28. An increase in the absolute number of lymphocyte in an adult blood smear would most likely indicate?

(A) viral infection*

(B) allergic reaction--eosinophil, basophil

(D) bacterial infection--neutrophil, fungal infection

29. Red blood cells on a stained blood smear appear to have varied abnormal shapes. This would be referred to as

(A) microcyte

(B) acanthocyte

(D) poikilocytosis*

Figure 5

I. the date

II. medical history

III. patient’s full name

IV. unique identification number

30. What information in Figure 5 should be included on a blood specimen label?

(A) I, II, III

(B) I, II, IV

(D) I, II, III, IV

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Name FOUR (4) precaution procedure during blood withdrawal and collection. (4 Marks)

avoid collection on hematoma

avoid collection on edematous

avoid collection on side of mastectomy

avoid collection at scarred area

b. State FOUR (4) methods to prevent hemolysis on blood specimen. (4 Marks)

correct needle size

tourniquet 1 min

air leakage needle

room temperature

hematoma never

loss of vacuum in tube

c. Draw and label vacuum venipuncture. (2 Marks)

2. a. List FOUR (4) functions of peripheral blood film (PBF). (4 Marks)

hematological problems

parasite, malaria

anemia

cell count

appearance

low cost

b. Write a short note on procedure of preparing PBF using push slide method. (6 Marks)

place a drop of blood

30~45 degrees

move spreader back and forth

dry

3. a. Describe the function of hemoglobin. (2 Marks)

carry oxygen to tissues

carry CO2 to lungs

b. List the hemoglobin concentration and hematocrit values for normal adult males and adult females. (4 Marks)

c. Provide the reference ranges for mean corpuslar volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC) and differential count for normal adults. (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Summarize the procedure of full blood count (FBC) whole blood analysis by hematology analyzer. (20 Marks)

Question 2

With aid of diagrams, explain in details the differences between granulocytes and agranulocytes. (20 Marks)

Question 3

Create a laboratory Standard Operating Procedure (SOP) for manual erythrocyte sedimentation rate (ESR) using westergren method. (20 Marks)

August 2015

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTION

1. Life span of red blood cell (RBC) is

(A) 80 days

(B) 100 days

(D) 160 days

2. Thrombocytes is also known as

(A) platelet*

(B) stem cell

(D) white blood cell

3. Which of the following is the function of white blood cells?

(A) Transporting oxygen

(B) Producing hemoglobin

(D) Maintaining homeostasis

4. The diluent agent used for white blood count test is

(A) acetic acid*

(B) sodium citrate

(D) sodium carbonate

5. Determination of relative size of red blood cell 82-98 fl, indicate

(A) packed cell volume (PCV)

(B) mean corpuscular volume (MCV)*

(D) mean corpuscular hemoglobin concentration (MCHC)

6. Which of the following white blood cells is capable of phagocytosis?

(A) basophil

(B) neutrophil*

(D) lymphocyte

7. Which of the following is immature form of platelets?

(A) astrocytes

(B) melanocytes

(D) megakaryocytes*

8. Which of the following statements about erythrocytes is CORRECT?

(A) they clot blood

(B) they fight infection

(D) they are produced in the spleen

9. The hormone erythropoietin stimulates red blood cell production in the red bone marrow. Where in the body is erythropoietin produced?

(A) liver

(B) spleen

(D) thyroid

10. During adult life, the primary source of blood cells is the

(A) liver

(B) spleen

(D) bone marrow*

11. Heme synthesis in immature RBC occurs largely in the

(A) nuclei

(B) ribosomes

(D) mitochondria*

12. What would happen to red blood cells if the heme group were removed from hemoglobin?

(A) Blood clot formation would be inhibited.

(B) Red blood cells would bot be able to reproduce.

(D) Red blood cells would not be able to bind oxygen.*

https://global.oup.com/uk/orc/pharmacy/ifp_therapeutics/student/mcqs/ch09/

13. Normal adult hemoglobin A (Hb A) contains the following polypeptide chains

(A) alpha (α) and beta (β)*

(B) alpha (α) and delta (δ)

(D) alpha (α) and gamma (γ)

14. The distribution of normal hemoglobin (Hb) in adults is

(A) 85 – 90% Hb A, 3 – 7% Hb A2, 2 – 3% Hb F

(B) 80 – 90% Hb A, 5 – 10% Hb A2, 1 – 5% Hb F

(D) 96 – 98% Hb A, 1.5 – 3.2% Hb A2, 0.5 – 0.8% Hb F*

15. In iron cycle, the transferrin receptor carries

(A) transferrin-bound iron in the plasma*

(B) transferrin-bound iron into erythrocytes

(D) iron out of duodenal cells from the intestinal lumen--DMT1

16. Below are the globin genes on the chromosome 11, EXCEPT

(A) beta (β)

(B) alpha (α)*--zeta

(D) gamma (γ)

17. Allergic reactions are frequently associated with an increase in the presence of

(A) monocytes

(B) neutrophils

(D) lymphocytes

18. Anticoagulant is an additive to

(A) make a blood clot faster

(B) ensure sterility of the tube

(D) prevent the blood from clotting*

19. Which anticoagulants prevent coagulation by inhibiting thrombin?

(A) EDTA

(B) heparin*

(D) sodium fluoride

20. Blood collection tubes must be drawn in a specific order to avoid

(A) underfilling tubes

(B) additive carry-over*

(D) excessive anticoagulation

21. Which of the following is the formation of blood clot?

(A) coagulation*

(B) chemotaxis

(D) erythropoiesis

22. Venipuncture blood is most commonly obtained from

(A) basilica vein

(B) cephalic vein

(D) median antebrachial vein

23. Figure 1 demonstrates which of the following venipuncture?

(A) capillary puncture

(B) vacuum venipuncture

(D) venipuncture syringes and needle

Figure 2

24. Which of the following is phlebotomy complication shown in Figure 2?

(A) petechiae*

(B) hemolysis

(D) hemoconcentration

25. Recommended needle position for venipuncture with surface of the arm is

(A) 45 degree

(B) < 10 degree

(D) 15 – 30 degree*

26. Which of the following statement indicate the proper blood’s microcollection site of choice?

(A) Toe prick is the best choice for adult.

(B) Heel puncture is the best site for neonates.*

(D) Earlobe is a puncture site for both adult and infants.

27. Which of the following would correlate with an elevated erythrocyte sedimentation rate (ESR) value?

(A) hypertension

(B) inflammation*

(D) decreased globulins

28. The normal number of reticulocyte count in an adult does NOT exceed

(A) 0.5

(B) 1.0

(D) 2.0*

29. The ratio of blood towards 3.8% sodium citrate in erythrocyte sedimentation rate (ESR) is

(A) 1:1

(B) 1:4*

(D) 1:9

30. Which of the following anticoagulant is the MOST suitable with the criteria in

• 10% dilution of blood

• blood volume less than 90% fill will falsely elevate a PTT result

• used for platelet aggregation studies

Figure 3.

Figure 3

(A) heparin

(B) warfarin

(D) sodium fluoride

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State FOUR (4) areas that need to be avoided when choosing site for venipuncture. (4 Marks)

b. Give FOUR (4) laboratory tests that cannot be performed on capillary specimens. (4 Marks)

c. Draw the suitable site for heel puncture on infant and give the reason of your answer. (2 Marks)

2. a. Define heme and globins. (2 Marks)

b. Write FIVE (5) biochemical components needed for heme synthesis. (5 Marks)

c. List THREE (3) results of hemoglobins degradation. (3 Marks)

3. a. Define the following terms: (4 Marks)

i. Packed cell volume (PCV)

ii. Mean corpuscular volume (MCV)

iii. Mean corpuscular hemoglobin (MCH)

iv. Mean corpuscular hemoglobin concentration (MCHC)

b. Based on the following haematological result find the calculation of MCV, MCH, MCHC.

Hematological test Result

Red blood cell count 5.5 x 1012/L

Hemoglobin concentration 16 g/dL

Hematocrit/packed cell volume 45% or 0.45 L/L

(6 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

Create a laboratory Standard Operating Procedure (SOP) for manual white blood cell (WBC) counting using Neubauer chamber count. (20 Marks)

Question 2

Explain in details the preparation of blood smear and discuss the common problem occur in the preparation. (20 Marks)

Question 3

With an aid of diagram, write the method of hematocrit and summarize the sources of errors in a micro-capillary measurement of hematocrit value. (20 Marks)

January 2015

SECTION A: OBJECTIVE QUESTIONS (30 MARKS)

CHOOSE ONE BEST STATEMENT TO ANSWER THE QUESTIONS

1. Blood cells make up how many percents of the total blood volume?

(A) 35

(B) 45*

(D) 65

2. Plasma is a substance without

(A) albumin

(B) globulin

(D) cholesterol*

3. Which of the following developmental sites for haematopoiesis is CORRECT?

(A) thymus  yolk sac  spleen

(B) liver  yolk sac  bone marrow

(D) bone marrow  liver  yolk sac

4. This stage of erythropoiesis may be found in both bone marrow and peripheral blood:

(A) erythroblast

(B) reticulocyte*

(D) basophilic erythroblast

5. White blood cells with coarse, strongly basophilic cytoplasmic granules are

(A) basophils*

(B) monocytes

(D) neutrophils

6. Identify the phagocytotic white blood cells:

(A) basophils

(B) eosinophils

(D) lymphocytes

7. Which of the following statements is FALSE about monocyte?

(A) involved in phagocytosis

(B) its nucleus varies in form

(D) the immature state of thromboblast*

8. In human adults, highest concentration of active marrow may be found in

(A) ribs

(B) pelvis*

(D) ends of long bones

9. Which is a CORRECT sequence for granulocyte development?

(A) myeloblast  metamyelocyte  myelocyte  promyelocyte  band

(B) myeloblast  metamyelocyte  promyelocyte  myelocyte  band

(D) myeloblast  myelocyte  promyelocyte  metamyelocyte  band

10. The primary function of anticoagulant is to

(A) make blood lyses faster

(B) dilute blood before testing

(D) prevent blood from clotting*

11. Which of the following anticoagulants acts by inhibiting thrombin formation?

(A) EDTA

(B) heparin*

(D) sodium fluoride

12. Which of the following is NOT TRUE regarding EDTA?

(A) It can be used to study blood cells morphology.

(B) It interferes with the staining of white blood cells.

(D) It is an acronym for ethylene-diamine-tetra-acetic acid.

13. The anticoagulant of choice for coagulation tests is

(A) EDTA

(B) heparin

(D) sodium fluoride

14. A single haemoglobin molecule is composed of

(A) protoporphyrin and four globin chains

(B) four heme molecules and four globin chains*

(D) ferrous iron, protoporphyrin and four globin chains

15. Haem synthesis in immature RBCs occurs largely in the

(A) nuclei

(B) ribosomes

(D) mitochondria*

16. Hemoglobin F structure consists of which globin chains?

(A) beta (β) and delta (δ)

(B) alpha (α) and beta (β)

(D) alpha (α) and gamma (γ)*

17. Identify the CORRECT distribution of normal hemoglobin in adults

(A) >95% HbA, 5% HbA2, 1% HbF

(B) >95% HbA, <3.5% HbA2, <1-2% HbF*

(D) 80-90% HbA2, 5-10% HbA, 1-5% HbF

18. In red blood cells destruction, the protoporphyrin is broken down into

(A) iron

(B) bilirubin*

(D) amino acids

Figure 1

19. The thin blood film in Figure 1 is not ideal because it

(A) is too thin

(B) is too short*

(D) is not evenly spreaded

20. The outcome of thin blood film as in Figure 1 may be due to the

(A) drop of blood (too much)

(B) angle of spreader (too high)*

(D) spreader edge (uneven or pitted edge)

21. A small, agranular leukocyte with dark blue and round nucleus refers to

(A) monocytes

(B) reticulocyte

(D) megakaryocyte

22. Which of the following does not affect the sedimentation rate of ESR?

(A) plasma protein concentration

(B) concentration of erythrocytes

(D) number and size of rbc structures

23. Which of the following conditions may result in an increased ESR?

(A) microcytosis

(B) polycythaemia

(D) Rouleaux Formation*

24. Which of the conditions below may increase the hematocrit value?

(A) hypoxia*

(B) hemolysis

(D) massive blood loss

25. What is the normal packed cell volume (PCV) value in adult male?

(A) 32 – 42%

(B) 37 – 47%

(D) 47 – 57%

Figure 2

26. RBCs in Figure 2 were stained using supravital stain. Black arrows show the

(A) basophils

(B) rubricytes

(D) reticulocytes*

27. The following data were obtained from an EDTA-anticoagulated blood:

Erythrocyte count = 3.92 x 1012/L; hemoglobin = 11.4 g/dL; hematocrit = 34% (0.34 L/L). Calculate the MCH.

(A) 29.1 pg

(B) 33.5 pg

(D) 86.7 pg

28. The following data were obtained from an EDTA-anticoagulated blood

Erythrocyte count = 4.05 x 1012/L; hemoglobin = 10.7 g/dL; hematocrit = 37% (0.37 L/L). Calculate the MCV.

(A) 28.9 fl

(B) 34.6 fl

(D) 264.1 fl

29. Which of the following diluents is used for manual RBC counts?

(A) 1% formalin.

(B) 3% acetic acid.

(D) 0.85% sodium chloride.*

30. What is the MOST possible condition of a patient with reticulocyte count of 30 per 500 erythrocytes?

(A) healthy

(B) leukemia

(D) bone marrow failure

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. Describe THREE (3) characteristics of hematopoietic stem cell. (6 Marks)

b. List FOUR (4) cell stages in monopoiesis. (4 Marks)

2. a. State FIVE (5) characteristics that anticoagulants should have. (5 Marks)

b. List FIVE (5) disadvantages of heparin anticoagulant. (5 Marks)

3. a. Define supravital stain. (2 Marks)

b. State FOUR (4) stages of reticulocyte staining. (4 Marks)

c. Briefly illustrate packed cell volume (PCV) measurement in a capillary tube. (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question 1

With aid of diagrams, explain Wedge slide procedure. (20 Marks)

Question 2

Discuss the mechanical and biological sources of errors in microcapillary measurement of hematocrit value. (20 Marks)

Question 3

Discuss the manual white blood cell (WBC) counting. (20 Marks)

August 2014

1. Which of these cells have biconcave shape in appearance?

(A) plasma

(B) platelets

(D) erythrocytes*

2. Antibody is contained in

(A) plasma

(B) platelets

(D) erythrocytes

3. The process of blood balances the pH and water throughout our body is called as

(A) initiation

(B) protection

(D) transportation

4. Which of the following organs is the site for embryo hematopoiesis?

(A) Liver

(B) Thymus

(D) Lymph node

5. The ability of the RBC to pass through the small blood vessel (capillary) is called as

(A) fluidity

(B) elasticity

(D) transformability

6. The haemoglobin is composed of

(A) four haem group, two iron, two globin chain

(B) two haem group, two iron, four globin chain

(D) four haem group, four iron, four globin chain*

7. Commercialized anticoagulant may be used to treat these disease

(A) Anemia, thalassemia, sickle cell anemia.

(B) Acute myeloid leukemia, acute lymphocytic leukemia.

(D) Atherosclerosis, myocardial infarction, venous thrombosis.

Figure 1

Which is the BEST description for chemical compound that are stated in Figure 1?

(A) endogenous anticoagulants

(B) catalyse for anticoagulants

(D) end products of anticoagulants reaction

9. The parameter that is being measured by spectrophotometer in making the cyanmethaemoglobin standard graph is

(A) colour

(B) volume

(D) concentration

10.

Figure 2

Figure 1 shows the cyanmethaemoglobin standard graph. Name X and Y

(A) X is absorbance, Y is standard concentration

(B) X is standard concentration, Y is absorbance*

(D) X is colour intensity, Y is sample concentration

11. Counting chamber is using

(A) Drabkins ruling

(B) Neubauer ruling*

(D) Haemocytometric ruling

12. Choose the CORRECT haematopoiesis process

(A) Differentiation formation development

(B) Formation development differentiation*

(D) Formation differentiation development

13. Monocytes are differed from lymphocytes by

(A) large variation in size*

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low N:C ratio with intense basophilia on the cytoplasmic edges

14. To protect the host from helminth is the function of

(A) eosinophils*

(B) basophils

(D) lymphocytes

15. The cell that is smaller than other leukocytes, larger than red blood cells, and involves in the blood coagulation called as

(A) monocytes

(B) erythrocytes

(D) thrombocytes

16. Calculate the hemoglobin concentration if a sample of female blood has the absorbance (Abs) = 0.310. Given the standard concentration given is 20 g/dL and Abs. = 0.500.

(A) 12.40 g/dL

(B) 13.56 g/dL

(D) 14.34 g/dL

17. Calculate the total red blood cell count if a sample of male blood gives a total number of red blood cells counted in Neubauer chamber is 450. Given the volume counted = 0.02 μL, dilution factor = 200 and area of chamber = 106 L.

(A) 4.5 X 1012 / L

(B) 6.5 X 1012 / L

(D) 6.0 X 1012 / L

18. Given the number of platelets counted in the Neubauer chamber is 1000. The volume counted is 0.1 μL, the dilution factor is 20 and area of chamber is 106 L. Calculate the total platelet count

(A) 210 X 109 /L

(B) 240 X 109 /L

(D) 200 X 109 /L

19. A disease that is likely to give a high platelet count above the normal range is

(A) thrombosis

(B) thrombocytosis*

(D) thrombocytopenia

20. Which of the following statement is TRUE for stem cells?

(A) Pluripotential stem cells are cells that are immature.

(B) Progenitor cells are cells that will not form many types of cells.

(D) Pluripotential stem cells are cells that are mature enough to form erythrocytes.*

21. Which of the following is the example for Romanowsky stain?

(A) Carnoy stain

(B) Leishman stain*

(D) Hematoxylin stain

22. Romanowsky stain will macroscopically give the colour of slide to be

(A) purple red in colour

(B) purple blue in colour*

(D) purple yellow in colour

23. Lymphocytes differs from monocytes by having

(A) large variation in size

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low N:C ratio with intense basophilia on the cytoplasmic edges

24. To protect the host from hypersensitivity reaction is the primary function of

(A) basophils*

(B) eosinophils

(D) lymphocytes

25. Reticulocyte count can be done by using

(A) Leishman stain

(B) Hematoxylin stain

(D) Brilliant cresyl blue stain*

26. Hypersplenism is characterized by

(A) pancytosis

(B) leukopenia*

(D) myelodysplasia

27. Which organ removes erythrocyte inclusions without destroying the cells?

(A) Liver

(B) Spleen*

(D) Lymph nodes

28. A falsely elevated hematocrit is obtained using a defective centrifuge. Which of the following calculated values will not be affected?

(A) MCV

(B) MCH*

(D) MCHC

29. Hematocrit determination test is also called as

(A) erythrocyte volume fraction*

(B) erythrocyte volume expander

(D) erythrocyte sedimentation fraction

30. Which of the following statement is FALSE for erythrocyte sedimentation rate?

(A) It can be done with 2 methods which are Wintrobe and Westergren method.

(B) It can be done for more than 1 hour provided the tube is maintained vertical.*

(D) It can produce rouleaux formation of red blood cells in pathological conditions.

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

ANSWER ALL QUESTIONS

1. a. State the number of chamber in haemocytometer and give the name of the common rule used for it. (2 Marks)

b. Briefly describe the improper techniques in counting the cells with haemocytometer. (3 Marks)

c. Given the volume counted = 0.02 μL, dilution factor = 200 and per litre = 106 L. Calculate the total red blood cell count if the red blood cells counted in the counting chamber is 500. (3 Marks)

d. The reference range of a male red cell count is 4.5 - 6.5 X 1012 / L, assuming that a man presenting the result above, what is the significance of the result? (2 Marks)

2. a. Draw and label the composition of haemoglobin. (4 Marks)

b. Define haemoglobinopathies and give an examples. (2 Marks)

c. Explain briefly on Drabkin’s solution and its effect on red blood cells. (4 Marks)

3. a. Define the haematology term and haematopoiesis term.

i. Haematology (1 Mark)

ii. Haematopoiesis (2 Marks)

b. Briefly explain with the aid of an examples, THREE (3) major functions of blood (3 Marks)

c. In your own words, describe briefly on blood in general. (4 Marks)

SECTION C : ESSAY QUESTIONS (40 MARKS)

ANSWER TWO (2) QUESTIONS ONLY

Question1

Elaborate the red blood cell indices which include MCV, MCH, and MCHC. (20 Marks)

Question2

With the aid of a diagram, compare and contrast the characteristics of FIVE (5) types of leukocyte cells. (20 Marks)

Question 3

Discuss in details the common problems that can happen with push slide smearing method. (20 Marks)

January 2014

1. Which of these cells are involved in the process of hemostasis?

(A) plasma

(B) platelets*

(D) erythrocytes

2. Fifty-five percent (45%) of the human blood is composed of

(A) plasma--55%

(B) platelets

(D) erythrocytes

3. Blood balances the pH and water throughout our body. This is an example of:

(A) initiation

(B) protection

(D) transportation

4. A common site of adult extramedullary hematopoiesis is the

(A) liver*

(B) thymus

(D) lymph node

5. What property of the normal erythrocytes allows the squeezing through the blood vessels?

(A) fluidity

(B) elasticity

(D) transformability

6. Which of the following is the molecular structure of the haemoglobin?

(A) four haem group, two iron, two globin chain

(B) two haem group, two iron, four globin chain

(D) four haem group, four iron, four globin chain*

7. Which diseases use anticoagulants as therapy?

(A) Anemia, thalassemia, sickle cell anemia.

(B) Acute myeloid leukemia, acute lymphocytic leukemia.

(D) Atherosclerosis, myocardial infarction, venous thrombosis.

Figure 1

 Antithrombin III

 Protein C

 Thrombomodulin

What is the property of chemical compounds in Figure 1?

(A) endogenous anticoagulants

(B) catalase for anticoagulants

(D) end products of anticoagulants reaction

9. What do you measure with spectrophotometer when generating the cyanmethemoglobin graph?

(A) colour

(B) volume

(D) concentration

10.

Figure 1

Figure 1 shows the cyanmethaemoglobin standard graph. X and Y denotes for

(A) X is absorbance, Y is standard concentration

(B) X is standard concentration, Y is absorbance*

(D) X is colour intensity, Y is sample concentration

11. The principle used in counting the cells using the counting chamber is

(A) Drabkins ruling

(B) Neubauer ruling*

(D) Haemocytometric ruling

12. Which flow is TRUE for haematopoiesis?

(A) differentiation formation development

(B) formation development differentiation*

(D) formation differentiation development

13. The following differentiate lymphocytes from monocytes EXCEPT

(A) large variation in size

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low N:C ratio with intense basophilia on the cytoplasmic edges*

14. The primary function of basophils is to

(A) protect the host from helminth parasites

(B) protect the host from autoimmune destruction*

(D) secrete cytokines to attract lymphocytes to the site of infection

15. This cell is smaller than other leukocytes, larger than red blood cells, has transparent cytoplasm, a round & large nucleus occupying most of cytoplasm. This cell is

(A) Monocytes

(B) Erythrocytes

(D) Thrombocytes

16. A sample of female blood has the absorbance (Abs) = 0.510. Given the standard concentration given is 20 g/dL and Abs. = 0.500, calculate the hemoglobin concentration.

(A) 12.40 g/dL

(B) 13.56 g/dL

(D) 23.56 g/dL

17. A sample of male blood gives a total number of red blood cells counted in Neubauer chamber is 250. Given the volume counted = 0.02 μL, dilution factor = 200 and area of chamber = 106 L. Calculate the total red blood cell count.

(A) 2.5 X 108 / L

(B) 3.5 X 108 / L

(D) 3.0 X 108 / L

18. Given the number of platelets counted in the Neubauer chamber is 750. The volume counted is 0.1 μL, the dilution factor is 20 and area of chamber is 106 L. Calculate the total platelet count

(A) 1.5 X 109 /L

(B) 1.6 X 109 /L

(D) 2.6 X 109 /L

19. A disease that is likely to give a high platelet count above the normal range is

(A) thrombosis

(B) thrombocytosis*

(D) thrombocytopenia

20. Which of the following statement is TRUE for stem cells?

(A) Pluripotential stem cells are cells that are mature.

(B) Progenitor cells are cells that have undergone differentiation process.

(D) Progenitor cells are cells that will undergo another differentiation to form many types of cells.

21. Which of the following is the example for Romanowsky stain?

(A) Carnoy stain

(B) Leishman stain*

(D) Hematoxylin stain

22. Romanowsky stain will macroscopically give

(A) purple red colour

(B) purple blue colour*

(D) purple yellow colour

28. Given the number of platelets counted in the Neubauer chamber is 550. The volume counted is 0.2 μL, the dilution factor is 20 and area of chamber is 106 L. Calculate the total platelet count

(A) 45 X 109 /L

(B) 55 X 109 /L

(D) 75 X 109 /L

29. Hematocrit determination test is also known as

(A) erythrocyte volume fraction*

(B) erythrocyte volume expander

(D) erythrocyte sedimentation fraction

30. Which of the following statement is FALSE for erythrocyte sedimentation rate?

(A) It can be done with 2 methods which are Wintrobe and Westergren method.

(B) It can be done for more than 1 hour provided the tube is maintained vertical.*

(D) It can fall faster when the size of the particles are larger as it makes it heavier.

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1.a State the common rule for cell counting and how many types of counting chambers are available . (2 Marks)

.b List THREE (3) things that you should avoided in counting cells using haemocytometer. (3 Marks)

.c Given the volume counted = 0.02 μL, dilution factor = 200 and per litre = 106 L. Calculate the total red blood cell count if the red blood cells counted in the counting chamber is 350. (3 Marks)

.d The reference range of a male is 4.5 - 6.5 X 1012 / L. Assuming that a man presenting the result in 1.c, what is the significance of the result? (2 Marks)

2.a State the the building block of haemoglobin. (2 Marks)

.b Give TWO (2) types of haemoglobinopathies. (2 Marks)

.c Drabkin’s solution, a lysing agent is added to the sample of the diluted blood in cyanmethaemoglobin method. Describe briefly its effect on red blood cells. (2 Marks)

.d State the standard wavelength used in cyanmethemoglobin measurement and give reason why do you develop the standard graph from the measurement. (2 Marks)

.e List TWO (2) advantages of Drabkin’s solution in haemoglobin estimation (2 Marks)

3.a Define the following term;

i. Haematology (1 Mark)

ii. Haematopoiesis (2 Marks)

.b State, with examples, THREE (3) major functions of blood. (3 Marks)

.c In your own words, describe briefly about blood in general. (4 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question1

In your own words, explain red blood cell indices. (20 Marks)

Question2

Explain the haemoglobin synthesis. (20 Marks)

Question 3

Summarize the differences in details between granulocytes and agranulocytes. (20 Marks)

August 2013

1. The following are components of blood EXCEPT

(A) water

(B) leukocytes

(D) melanocytes*

2. Hematopoiesis is defined as the production of

(A) blood*

(B) stem cells

(D) erythrocytes

3. Which of the following are components of plasma?

I. mineral

II. albumin

III. globulin

IV. fibrinogen

(A) I, II and IV

(B) I, III and IV

(D) All of above*

4. A common site of postnatal haematopoiesis is the

(A) liver

(B) thymus

(D) bone marrow*

5. Which of the following statement is FALSE regarding adult bone marrow?

(A) It produces hemoglobin.

(B) It secretes erythropoietin.

(D) It encompasses progeny of stem cell which proliferate and differentiate to produce mature cells.*--progenitor cells

6. The major defense for our bodies against invading bacteria and virus is

(A) plasma

(B) platelets

(D) white blood cell*

7. Anticoagulant is

(A) an anti-thrombin

(B) present in blood to prevent blood clotting

(D) a chemical responsible to preserve blood sample*

8. Haemocytometer is

(A) disposable

(B) a Thoma pipette

(D) commonly used today for red blood cell count

9. Which of the following is TRUE regarding hemoglobin synthesis?

(A) Vitamin B12 is a coenzyme for haem synthesis.--V B6

(B) Most of the hemoglobin is synthesized in the erythroblast.*

(D) Haem synthesis occurs largely in the ribosomes of immature RBC.--mitochondria

10. The MOST common staining for peripheral blood film analysis is

(A) Carnoy stain

(B) Acid-fast stain

(D) Hematoxylin stain

11. Which flow is TRUE for thrombopoiesis?

(A) pleuripotent stem cells megakaryoblast promegakaryocyte megakaryocyte platelet*

(B) megakaryoblast pleuripotent stem cells promegakaryocyte megakaryocyte platelet

(D) pleuripotent stem cells megakaryoblast promegakaryocyte megakaryocyte platelet*

12. Which of the following parameter is NOT included in a complete blood count?

(A) platelet count

(B) leukocytes count

(D) hemoglobin count*

13. The primary function of erythrocyte sedimentation rate (ESR) is to measure the

(A) rate of RBC falling size particles

(B) sedimentation rate of erythrocytes in serum

(D) sedimentation rate of plasma protein composition

14. The structure of hemoglobin F is

(A) 2α and 2β

(B) 2α and 2δ

(D) 2α and 2∞

15. Which of the following statement is TRUE for EDTA (ethylene diamine tetra acetic acid)?

(A) The EDTA forms soluble calcium salts by chelation process.

(B) It is mainly used as anticoagulant in blood sample for blood cell count.

(D) It is the anticoagulant of choice for studies of platelet function and morphology.*--sodium citrate

16. A sample of male blood gives a total number of red blood cells counted in Neubauer chamber is 450. Given the volume counted = 0.02 μL, dilution factor = 200 and area of chamber is 106 L. Calculate the total red blood cell count.

(A) 4.5 X 1012 / L.

(B) 6.5 X 1012 / L.

(D) 6.0 X 1012 / L.

17. Lymphocytes can be differentiated from monocytes because lymphocytes have

(A) large variation in size

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low N:C ratio with intense basophilia on the cytoplasmic edges

18. The ESR will increase in the following conditions EXCEPT

(A) anaemia

(B) menstruation

(D) polycythaemia*

19. Platelets are described as

(A) anticoagulants

(B) important source of thrombin*

(D) increasing in number in patients with viral infection

20. Which of the following is the example for Romanowsky stain?

(A) Gram stain

(B) Carnoy stain

(D) Hematoxylin stain

21. Staining used in determining the reticulocyte count is

(A) Leishman stain

(B) Hematoxylin stain

(D) Brilliant cresyl blue stain*

22. The primary function of monocyte is to

(A) protect the host from viral infection

(B) remove and process dead cells and debris*

(D) secrete cytokines to attract monocytes to the site of infection

23. Which of the following is TRUE about red blood cell (RBC)?

(A) It has a lifespan around two days.

(B) It has normocytic morphology and a biconcave disc shape.*

(D) Iron and vitamin B complex are important elements for its development.

24. Red blood cell indices are measurement of the following EXCEPT

(A) packed cell volume*

(B) mean corpuscular volume

(D) mean corpuscular hemoglobin concentration

25. Which of the following pairs is FALSE regarding RBC indices and anaemia?

(A) low MCV value – microcytic anaemia

(B) high MCV value – macrocytic anaemia

(D) low MCHC value – microcytic anaemia*--hypochromic and normochromic

26. Which of the following statement is TRUE for reticulocyte count?

(A) It will count the mature erythrocytes.

(B) Increase value represent tumor in bone marrow.

(D) New methylene blue is used for the staining of reticulocytes.*

27. Hematocrit determination test is also known as

(A) erythrocyte volume fraction*

(B) erythrocyte volume expander

(D) erythrocyte sedimentation fraction

28. Which of the following statement is FALSE for ESR?

(A) The sedimentation rate depends on the number and size of erythrocytes.

(B) It can be done for more than 1 hour provided the tube is maintained vertical.*

(D) It can fall faster when the size of the particles are larger as it makes it heavier.

29. What is the parameter that is being measured by spectrophotometer in the cyanmethaemoglobin standard graph?

(A) colour

(B) volume

(D) concentration

30. Which of the following statement is FALSE regarding heparin?

(A) Heparin is also known as anti-thromboplastin.

(B) It is commonly used in detection of blood pH and blood gas analysis.

(D) It cannot preserves the staining and morphological characteristics of leukocytes.

SECTION B : SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a. Name SIX (6) parameter test exist by complete blood count. (6 Marks)

b. Distinguish between WBC differential count and leukocyte count. (4 Marks)

2. a. Briefly explain the function of blood. (4 Marks)

b. Give FOUR (4) function of full blood picture. (4 Marks)

c. Name TWO (2) types of anticoagulants. (2 Marks)

3. a. Define hematocrit and briefly describe the principle. (4 Marks)

b. Define ESR and briefly describe the principle. (4 Marks)

c. Name TWO (2) methods available for ESR. (2 Marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question 1

Describe in details about red blood cell indices. (20 Marks)

Question 2

With the aid of a diagram, classify and explain the characteristics of white blood cells. (20 Marks)

Question 3

Explain in details the preparation of blood smear or thin blood film, and the procedure of RBC and WBC count measurement using haemocytometer. (20 Marks)

January 2013

1. The transport of oxygen and carbon dioxide between the lungs and body tissue is done by

(A) plasma

(B) platelets

(D) erythrocytes*

2. Fifty-five percent (55%) of the human blood is composed of

(A) plasma*

(B) platelets

(D) erythrocytes

3. Blood balances the pH and water throughout our body. This is an example of:

(A) initiation

(B) protection

(D) transportation

4. A common site of adult extramedullary hematopoiesis is the

(A) liver*--spleen

(B) thymus

(D) lymph node

5. What property of the normal erythrocytes membrane allows the 7 μM cell to squeeze through 3 μM fenestration in the spleen?

(A) fluidity

(B) elasticity

(D) transformability

6. Which of the following is the CORRECT molecular structure of the haemoglobin?

(A) four haem group, two iron, two globin chain

(B) two haem group, two iron, four globin chain

(D) four haem group, four iron, four globin chain*

7. Based on your knowledge, patients with which diseases use anticoagulants as part of their medication?

(A) Anemia, thalassemia, sickle cell anemia

(B) Acute myeloid leukemia, acute lymphocytic leukemia

(D) Atherosclerosis, myocardial infarction, venous thrombosis

Figure 1

Which is the BEST description for chemical compounds shown in Figure 1?

(A) endogenous anticoagulants

(B) catalyse for anticoagulants

(D) end products of anticoagulants reaction

9. In making the cyanmethaemoglobin standard graph, what is the parameter that is being measured by spectrophotometer?

(A) colour

(B) volume

(D) concentration

10.

Figure 1

Figure 1 shows the cyanmethaemoglobin standard graph. X and Y denotes for

(A) X is absorbance, Y is standard concentration.

(B) X is standard concentration, Y is absorbance.*

(D) X is colour intensity, Y is sample concentration.

11. The MOST common rule used in counting chamber is

(A) Drabkins ruling

(B) Neubauer ruling*

(D) Haemocytometric ruling

12. Which flow is TRUE for haematopoiesis?

(A) Differentiation formation development

(B) Formation development differentiation*

(D) Formation differentiation development

13. Monocytes can be differentiated from lymphocytes because monocytes have a

(A) large variation in size*

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low N:C ratio with intense basophilia on the cytoplasmic edges

14. The primary function of eosinophils is to

(A) protect the host from helminth parasites*

(B) protect the host from autoimmune destruction

(D) secrete cytokines to attract lymphocytes to the site of infection

15. This cell is smaller than other leukocytes, larger than red blood cells, transparent cytoplasm, round & large nucleus occupying most of cytoplasm which is called

(A) monocytes

(B) erythrocytes

(D) thrombocytes

16. A sample of female blood has the absorbance value (Abs) of 0.310. Given the standard concentration is 20 g/dL and Abs = 0.500, calculate the hemoglobin concentration.

(A) 12.40 g/dL.

(B) 13.56 g/dL.

(D) 14.34 g/dL.

17. A sample of male blood gives a total number of red blood cells counted in Neubauer chamber is 450. Given the volume counted = 0.02 μL, dilution factor = 200 and area of chamber is 106 L. Calculate the total red blood cell count.

(A) 4.5 X 1012 / L.

(B) 6.5 X 1012 / L.

(D) 6.0 X 1012 / L.

18. Given the number of platelets counted in the Neubauer chamber is 1000. The volume counted is 0.1 μL, the dilution factor is 20 and area of chamber is 106 L. Calculate the total platelet count.

(A) 210 X 109 /L.

(B) 240 X 109 /L.

(D) 200 X 109 /L.

19. A disease that is likely to give a low platelet count below the normal range is

(A) thrombosis

(B) thrombocytosis--increased

(D) thrombocytopenia*

20. Which of the following statement is FALSE for stem cells?

(A) Pluripotential stem cells are cells that are immature.

(B) Progenitor cells are cells that have undergone differentiation process.

(D) Progenitor cells are cells that will undergo another differentiation to form many types of cells.

21. Which of the following is the example for Romanowsky stain?

(A) Carnoy stain

(B) Leishman stain*

(D) Hematoxylin stain

22. Romanowsky stain will macroscopically give

(A) purple red colour

(B) purple blue colour*

(D) purple yellow colour

23. Lymphocytes can be differentiated from monocytes because lymphocytes have

(A) large variation in size

(B) more lobular nucleus and fine granular grey cytoplasm

(D) low N:C ratio with intense basophilia on the cytoplasmic edges

24. The primary function of basophils is to

(A) protect the host from helminth parasites

(B) protect the host from hypersensitivity reaction*

(D) secrete cytokines to attract lymphocytes to the site of infection

25. Staining used in determining the reticulocyte count is

(A) Leishman stain

(B) Hematoxylin stain

(D) Brilliant cresyl blue stain*

26. A sample of male blood has the absorbance value (Abs) of 0.490. Given the standard concentration is 30 g/dL and Abs. = 0.500, calculate the hemoglobin concentration.

(A) 10.40 g/dL.

(B) 19.40 g/dL.

(D) 29.40 g/dL.

27. A sample of male blood gives a total number of red blood cells counted in Neubauer chamber is 300. Given the volume counted = 0.01 μL, dilution factor = 200 and area of chamber = 106 L. Calculate the total red blood cell count.

(A) 4.5 X 1012 / L.

(B) 6.5 X 1012 / L.

(D) 6.0 X 1012 / L.

28. Given the number of platelets counted in the Neubauer chamber are 750. The volume counted is 0.2 μL, the dilution factor is 20 and area of chamber is 106 L. Calculate the total platelet count

(A) 70 X 109 /L.

(B) 75 X 109 /L.

(D) 85 X 109 /L.

29. Hematocrit determination test is also known as

(A) Erythrocyte volume fraction

(B) Erythrocyte volume expander

(D) Erythrocyte sedimentation fraction

30. Which of the following statement is FALSE for erythrocyte sedimentation rate?

(A) It can be done with 2 methods which are Wintrobe and Westergren method

(B) It can be done for more than 1 hour provided the tube is maintained vertical*

(D) It can fall faster when the size of the particles are larger as it makes it heavier

SECTION B: SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a. Name the rule of counting that is commonly used with the haemocytometer and how many counting chambers do the haemocytometer has. (2 Marks)

b. State the don’ts in counting the cells with haemocytometer. (3 Marks)

c. Given the volume counted = 0.02 μL, dilution factor = 200 and per litre = 106 L. Calculate the total red blood cell count if the red blood cells counted in the counting chamber is 500. (3 Marks)

d. The reference range of a male is 4.5 - 6.5 X 1012 / L. Assuming that a man presenting the result above, what is the significance of the result? (2 Marks)

2.a. State the composition of haemoglobin. (2 Marks)

b. Define haemoglobinopathies with examples. (2 Marks)

c. What are the effects of Drabkin’s solution on red blood cells. (2 Marks)

d. What is the standard wavelength and expectation on the standard graph obtained? (2 Marks)

e. List TWO (2) advantages of Drabkin’s solution in haemoglobin estimation (2 Marks)

3) Define the following term;

a. i Hematology (1 mark)

a. ii Haematopoiesis (2 marks)

b. State, with examples, THREE (3) major functions of blood. (3 marks)

c. In your own way, describe briefly about blood in general. (4 marks)

SECTION C: ESSAY QUESTIONS (40 MARKS)

Answer TWO (2) questions only.

Question1

In your own words, explain red blood cell indices. (20 Marks)

Question2

With the aid of a diagram, classify and explain the characteristics of FIVE (5) types of leukocyte cells. (20 Marks)

Question 3

Discuss in details the common problems encountered with push slide method. (20 Marks)

July 2012

1. In anticoagulated blood the formed elements can be separated by centrifugation from

(A) serum

(B) Plasma*

(D) cell suspension

2. Cyanmethemoglobin is the result of the quantitative conversion of all EXCEPT one of the following

(A) oxyhemoglobin

(B) methemoglobin

(D) carboxyhemoglobin

3. Hematocrit is the

(A) total red cell mass

(B) red cell distribution width

(D) percentage of packed erythrocyte in a whole blood sample*

4. The diluting fluid used for white blood count is

(A) acetic acid*

(B) sodium citrate

(D) sodium carbonate

5. When blood is drawn in a white pipette at the 0.5 mark and mixed with the diluting fluid to the mark 11, the dilution factor is

(A) 10

(B) 20*

(D) 40

11/0.5=22

6. Eosinophilic leukocytosis is found in peripheral smears in

(A) Leprosy

(B) viral infections

(D) bacterial infections

7. A ‘shift to the left’ indicate presence of immature

(A) platelets

(B) neutrophils*

(D) lymphocytes

8. The white cells with vacuoles in the cytoplasm and amoeboid nuclei are

(A) band cell.

(B) monocytes.

(D) lymphocytes.

9. The normal number of reticulated erythrocytes in an adult does NOT normally exceed

(A) 0.5 %

(B) 1.0 %

(D) 5.0 %

10. An MCV greater than 94 cu. indicates

(A) target cells

(B) macrocytes*

(D) spherocytosis

11. The most common hemoglobin type in normal individuals is

(A) Hb A*

(B) Hb F

(D) Hb S

12. Toxic granulation of neutrophils is usually caused by

(A) bleeding

(B) infection*

(D) chronic anemia

13. During influenza, there is an increased number of

(A) monocytes

(B) neutrophils

(D) lymphocytes*--humoral, cell-mediated

14. To obtain plasma from whole blood the anticoagulant bind to

(A) calcium*

(B) thrombin

(D) erythrocytes

15. The dye used for vital staining for the reticulocytes count is

(A) eosin

(B) violet fibre

(D) brilliant cresyl blue*

16. Leucopenia is a decrease in total white cells below

(A) 4000 per cu. mm*

(B) 6000 per cu. mm--4~7 y

(D) 10000 per cu. mm--birth

17. Low Erythrocyte Sedimentation Rate may be due to

(A) infection

(B) blood loss

(D) iron Deficiency Anemia

18. The common progenitor cells for neutrophis, eosinophils and basophils are the

(A) Monoblasts

(B) Myeloblasts*

(D) Lymphoblasts

19. If the total number of platelets counted in the 25 squares is 150, the total platelets count is___/ mm of blood.

(A) 3000

(B) 30000

(D) 3,000,000

150 x 200 x 10^6 / (25/400 x 0.1)

20. The MCV for a sample with Hb 10 g/dl, RBC 2.5 x106/mm and PCV 20% is

(A) 70 fl

(B) 80 fl

(D) 100 fl

21. The CORRECT sequence of hematopoiesis site of development is

(A) yolk sac, thymus, spleen.

(B) yolk sac, bone marrow, liver.

(D) yolk sac, thymus, bone marrow.

22. Which is the CORRECT sequence in formation of mature leukocyte?

(A) MyeloblastMetamyelocytePromyelocyteMyelocyteband form.

(B) MyeloblastPromyelocyteMyelocyteMetamyelocyteband*

(D) MyeloblastMetamyelocyteMyelocytePromyelocyteband.

23. Which anticoagulant prevents coagulation by inhibiting thrombin?

(A) EDTA.

(B) Heparin.*

(D) Sodium fluoride.

24. A hemoglobin molecule is composed of

(A) Protoporphyrin and four globin chains.

(B) Four heme molecules and four globin chains.*

(D) Ferrous iron, protoporphyrin and four globin chains.

25. What is the distribution of normal hemoglobin in adults?

(A) >95% HbA, 5% HbA2, 1% HbF.

(B) 80-90% HbA, 5-10% HbA2, 1-5% HbF.

(D) >95% HbA, <3.5% HbA2, <1-2% HbF.*

26. Which component of Leishman stain is responsible for the red-orange color of an erythrocyte?

(A) Eosin*

(B) Azure B

(D) Methylene blue

27. Which of the following conditions may NOT contribute to ESR?

(A) Platelets concentration*

(B) Plasma protein concentration

(D) Number and size of RBC structures

28. The following disorders will give an increased haematocrit value EXCEPT

(A) cancers

(B) hypoxia

(D) acute dehydration

29. The following erythrocyte data were obtained from an EDTA anticoagulated specimen: erythrocyte count = 3.90 x 10 12/L, hemoglobin = 12.0 g/dL, hematocrit = 35% (0.35 L/L).

Calculate the MCH.

(A) 20.7 pg

(B) 30.7 pg

(D) 50.7 pg

30. A reticulocyte count was performed, and 15 reticulocytes were counted in 500 erythrocytes. What is the reticulocyte count?

(A) 1%

(B) 2%

(D) 4%

PART B: Short Answer Questions (30 MARKS)

Answer ALL questions.

1 a. Explain the principle of the Cyanmethaemoglobin method of haemoglobin estimation. (3 marks)

b. What is the significance of a haemoglobin concentration of 8.5 g/dl? (3 marks)

c. Explain sources of error in the Cyanmethaemoglobin method of Hemoglobin Estimation. (4 marks)

2. a. What does Erythrocyte Sedimentation Rate (ESR) measure? (2 Marks)

b. Explain the significance of a low Erythrocyte Sedimentation Rate (ESR) and high Erythrocyte Sedimentation Rate (ESR). (4 marks)

c . What are the sources of error in Erythrocyte Sedimentation Rate (ESR) estimation ? (4 marks)

3 a . What is meant by anticoagulants? (2 Marks)

b . Briefly discuss the actions of common anticoagulants. (8 Marks)

PART C : ESSAY QUESTIONS (40 MARKS)

Answer TWO ( 2 ) questions only.

Question 1

a) Briefly discuss the principle of Romanowsky stains (20 Marks)

b) The sources of error in Leishman staining and

c) What does it mean by "good qualities of a thin blood film"

Question 2

Discuss the principle and application of the supra vital staining in Haematology. (20 Marks)

Question 3

Discuss leukocyte differential count. (20 Marks)

July 2011

1. The percentage of blood cells against the total blood volume is

(A) 40.

(B) 45.*

(D) 55.

2. Plasma is a fluid without

(A) albumin.

(B) globulin.

(D) cholesterol.*

3. The correct developmental site of the hematopoiesis is

(A) thymus, yolk sac, spleen.

(B) liver, yolk sac, bone marrow.

(D) bone marrow, liver, yolk sac.

4. Which of the following erythrocyte developmental stage can be found in both bone marrow and peripheral blood?

(A) Erythroblast.

(B) Reticulocyte.*

(D) Polychromatic erythroblast.

5. Identify the type of white blood cells (WBC) that has coarse and strongly basophilic cytoplasmic granules?

(A) Basophil*

(B) Monocyte

(D) Neutrophil

6. Which of the following WBCs kill bacteria by phagocytosis?

(A) Basophil

(B) Eosinophil

(D) Lymphocyte

7. Which of the following statement is FALSE for monocytes?

(A) Involved in phagocytosis

(B) Size is larger than lymphocytes

(D) The immature state of thromboblast*--monoblast

8. Active marrow can be found in higher concentration in

(A) Ribs.--9%

(B) Pelvis.*--40%

(D) Ends of long bones.--8%

sternum--2%

vertebrae--28%

9. Which is a correct sequence for granulocyte development?

(A) Myeloblast  Metamyelocyte  Promyelocyte  Myelocyte band.

(B) Myeloblast  Promyelocyte  Myelocyte  Metamyelocyte band.*

(D) Myeloblast  Metamyelocyte  Myelocyte Promyelocyteband.

10. Anticoagulant is an additive to

(A) make a blood clot faster.

(B) ensure the sterility of the tube.

(D) prevent the blood from clotting.*

11. Which anticoagulant prevents coagulation by inhibiting thrombin?

(A) EDTA

(B) Heparin*

(D) Sodium fluoride

12. Which of the following is FALSE with regards to EDTA anticoagulant?

(A) It can be used to study the blood cells morphology

(B) It forms insoluble calcium salts by chelation process

(D) It interferes with the staining of white blood cells (WBC)*

13. The anticoagulant of choice for the glucose tests is

(A) EDTA.

(B) heparin.

(D) potassium oxalate + sodium fluoride.*

14. A single hemoglobin molecule is composed of

(A) protoporphyrin and four globin chains.

(B) four heme molecules and four globin chains.*

(D) ferrous iron, protoporphyrin and four globin chains.

15. Haem synthesis in immature RBC occurs largely in the

(A) nuclei

(B) ribosomes

(D) mitochondria*

16. Hemoglobin F (HbF) molecule consists of which globin chains?

(A) alpha (α), beta (β)

(B) beta (β), gamma (γ)

(D) beta (β), delta (δ)

17. What is the distribution of normal hemoglobin in adults?

(A) 80-90% HbA, 5-10% HbA2, 1-5% HbF.

(B) 80-90% HbA2, 5-10% HbA, 1-5% HbF.

(D) >95% HbA, 5% HbA2, 1% HbF.

18. Hemoglobin A2 (HbA2) refers to the globin chains

(A) α and β.

(B) α and γ.

(D) α and ε.

19. In red cells destruction, the protoporphyrin is broken down into

(A) amino acids.

(B) creatinine.

(D) iron.

20. The above thin blood film is not ideal and this may result from

(A) a drop of blood is too large.

(B) the spreader is pushed too slowly.

(D) the angle of spreader is too upright (high).*

21. A small, agranular cell with dark blue and round nucleus seen in a Leishman-stained blood film could possibly a characteristic of

(A) platelet.

(B) monocytes.

(D) reticulocyte.

22. Which of the following conditions may NOT contribute to the sedimentation rate of ESR?

(A) Plasma protein concentration

(B) Concentration of erythrocytes

(D) Number and size of RBC structures

23. Which of the following conditions will result in an increased ESR?

(A) Rouleaux Formation*

(B) Afibrinogenaemia

(D) Microcytosis

24. Which of the conditions listed below can increase hematocrit value?

(A) Hypoxia*

(B) Hemolysis

(D) Massive blood loss

25. What is the normal range of a packed cell volume (PCV) in adult male?

(A) 32 – 42%

(B) 37 – 47%--female

(D) 47 – 57%

26. The arrows show the blood smear of X cells containing the dark blue RNA stained with New Methylene Blue stain. What are the X cells?

(A) Basophils

(B) Rubricytes

(D) Reticulocytes*

27. The following data were obtained from an EDTA-anticoagulated blood: erythrocyte count = 3.92 x 1012/L, hemoglobin = 11.4 g/dL, hematocrit = 34% (0.34 L/L). Calculate the MCH.

(A) 29.1 pg

(B) 33.5 pg

(D) 86.7 pg

28. The following data were obtained from an EDTA-anticoagulated blood: erythrocyte count = 4.05 x 1012/L, hemoglobin = 10.7 g/dL, hematocrit = 37% (0.37 L/L). Calculate the MCV.

(A) 28.9 fl

(B) 34.6 fl

(D) 264.1 fl

29. Which of the following diluents is used for manual RBC counts?

(A) 1% formalin.

(B) 3% acetic acid.

(D) 0.85% sodium chloride.*

30. What is the most possible condition of a patient with reticulocyte count of 42 per 500 erythrocytes?

(A) Healthy.

(B) Leukemia.

(D) Bone marrow failure.

PART B- SHORT ANSWER QUESTIONS (30 MARKS)

Answer ALL questions.

1. a) Define hematopoiesis. (2 Marks)

formation of blood

b) Describe THREE characteristics of hematopoietic stem cell. (6 Marks)

c) State any TWO (2) cell series in leucopoiesis. (2 Marks)

2. a) State FIVE (5) characteristics that anticoagulants should have. (5 Marks)

b) List FIVE (5) disadvantages of heparin anticoagulant. (5 Marks)

3. a) Define supravital stain. (2 Marks)

b) State FOUR (4) stages of reticulocyte staining. (4 Marks)

c) With aid of diagram and labels, illustrate the packed cell volume (PCV) measurement in a capillary tube. (4 Marks)

PART C: ESSAY (40 MARKS)

Answer TWO (2) questions only.

Question 1

With aid of diagrams, describe Wedge slide procedure . (20 Marks)

Question 2

Discuss the mechanical and biological sources of errors in a micro- capillary measurement of hematocrit value. (20 Marks)

Question 3

Discuss the manual white blood cell (WBC) counting. (20 Marks)

January 2010

PART A: OBJECTIVE QUESTIONS (30 marks)

1. Which is the BEST site to obtain venipuncture blood?

A. Median vein.

B. Basilic vein.

C. Median cubital vein.*

D. Cephalic vein.

2. The component of vacuum venipuncture are as follows EXCLUDE;

A. evacuated plastic tube

B. vacuum blood pump

C. plastic adapter

D. double pointed needle

3. Which of the following is TRUE indicating the blood’s microcollection site of choice?

A. Earlobe is a puncture site for adult and infants.

B. Heel puncture is the best site for neonates*

C. The first finger is the best site for finger prick.

D. Toe prick is the best choice for adult.

4. Which anticoagulant is the BEST use for blood gas analysis?

A. EDTA.

B. Acid citrate dextrose (ACD).

C. Heparin.*--blood pH

D. Sodium fluoride.

5. The anticoagulant use for glucose test is

A. sodium citrate + ACD

B. potassium oxalate + sodium fluoride*

C. heparin + EDTA

D. sodium fluoride + ACD

6. The main function of sodium citrate anticoagulant is to

A. perform blood smear

B. preserves the staining of RBC

C. determines Coomb’s test.

D. studies the blood coagulation assay.*

7. The ratio of blood towards 3.8% sodium citrate in ESR is

. A. 1:1

B. 1:2

C. 1:4*

D. 1:8

8. Which of the following is FALSE regarding EDTA anticoagulant?

A. Acts as a sequester agent by binding the calcium ion.*--forms calcium

B. The most common use is disodium (Na2EDTA)--K3EDTA

C. 0.5 mg EDTA is enough to preserve 1 ml of blood.--6 h

D. EDTA will interfere with the blood’s plasma fibrinogen test.

9. The component of serum are as follows EXCEPT

A. Fibrinogen*

B. Water

C. Mineral

D. Lipid

10. Which is a CORRECT sequence formation of mature erythrocyte?

A. proerythroblast  basophilic orthochromatic polychromaticretic

B. proerythroblast orthochromatic basophilic polychromaticretic

C. proerythroblast polychromaticbasophilicorthochromaticretic

D. proerythroblast basophilicpolychromaticorthochromaticretic*

11. Name the cell involve in destroy an invading bacteria in blood circulation.

A. eosinophil

B. neutrophil*

C. basophil

D. lymphocyte

12. What are the organs of haematopoiesis in fetal life?

A. Spleen and liver.*

B. Bone marrow.

C. Pancreas and kidney.

D. Thymus and thyroid gland.

13. Which of the following is NOT TRUE characteristic of the indicate cell?

A. Play a major role in the vasoconstriction of injury.--primary hemostasis

B. Have nuclear with discoid shape.

C. The life span is about 7-10 days.*

D. The production is regulated by interleukin.--thrombopoietin in liver

14. Which chemical substances are responsible for differentiation and replication of the pluripotent stem cell?

A. Cytokines.*

B. Insulin.

C. Thyroxin.

D. Oxygen.

15. A hormone release from a kidney that responsible for erythroid formation is

A. estrogen.

B. erythropoietin.*

C. G-CSF.

D. progestin.

16. Eosin Y is an anion dye of Romanowsky staining which binds to the cation site on the blood cell. Which of the following is NOT the cation component of the blood cell?

A. Eosinophil granules.

B. Hemoglobin granule.*

C. Basophil granule.

D. Red blood cell.

17. The Romanosky staining shows the color of cytoplasm with purple blue to lilac surrounded by blue color. No nucleus and no granules presence. The cell should be

A. platelet*

B. lymphocyte

C. monocyte

D. basophil

18. The cell is staining with Leishman stain and the result shows a dark blue color of cytoplasm, granules and nucleus. The cell should be

A. neutrophil.

B. basophil*

C. eosinophil

D. monocyte.

19. What are the criteria of unsatisfactory blood film?

A. The test must be done without delay.

B. Drop of blood is too large or too little.*

C. Used of anticoagulants does not change the morphology of blood cells.

D. Used an absolute methanol when the staining process is delayed.

20. When the iron in the hemoglobin molecule is in the ferric (Fe3+) state, hemoglobin is termed

A. carboxyhemoglobin.

B. methemoglobin.*

C. ferrihemoglobin.

D. sulfhemoglobin.

21. Below are the globin genes on the chromosome 11 EXCEPT

A. alpha*--zeta

B. beta

C. gamma

D. epsilon

22. The structure of HbF is

A. ς2γ2

B. α2ξ2

C. ς2ξ2

D. α2γ2*

23. The structure of HbA2 is

A. α2γ2

B. α2d2*

C. α2β2.

D. α2ξ2

24. How many total genes does a person possess for the production of alpha chains?

A. One.

B. Two.*

C. Three.

D. Four.

25. Calculation of RBC cells has been done on the on the hemocytometer chamber. What are the solution and dilution factor used?

A. Weak acetic acid: 200 dilution factor.*

B. Glacial acetic acid: 200 dilution factor.

C. Formal citrate: 200 dilution factor.

D. Trisodium citrate: 200 dilution factor.

26. What is the measurement unit for mean cell volume?

A. Picogram.

B. Femtoliter.*

C. Microgram.

D. Picomolar.

27. Which of the following information is needed for calculation of mean cell volume?

A. Haemoglobin.

B. Pack cell volume.*

C. Reticulocyte.

D. Total leukocytes.

28. The following disorder will give the increased hematocrit value EXCEPT

A. malignant condition

B. diarrhea.

C. acute dehydration.--severe

D. hypoxia.*--polycythemia

29. What is the factor that increases the rate of erythrocyte sedimentation rate settling?

A. Diluted RBC.

B. Anemia.

C. Smaller size of erythrocytes cells.*

D. Concentrated fibrinogen.

30. Which of the following is the source of ESR error that gives false decreased result?

A. The temperature is 40°C.

B. The blood is refrigerated.*--anticoagulated blood >2 h old, improper concentration of anticoagulant-whole blood ratio

C. The tube stand more than one hour.--less

D. The tube is not in the right position.

PART B: SHORT ANSWER QUESTIONS (40 marks)

Answer ALL questions.

1. a. Illustrate the pictured of mononuclear cells. (4 marks)

b. With an example, define the coagulant tubes. (2 marks)

2. a. What is the butterfly needle venipuncture? (2 marks)

b. State the condition of people that suits for winged infusion venipuncture. (2 marks)

c. Name the system use for gauging the needle size. (2 marks)

d. Draw the suitable site for finger prick puncture and give the reason of your answer. (3 marks)

e. Describe on the following picture. (3 marks)

2 heelstick have been performed on the baby

one is performed correctly

one is performed improperly

3. a. Name the terminology for push slide method and give the right angle for this method. (2 marks)

Wedge slide, 30~45

b. State FIVE (5) biochemical components needed for heme synthesis. (5 marks)

c. List TWO (2) hemoglobin presence in the embryonic stage. (2 marks)

4. a. Give the principle of ESR method. (2 marks)

b. State THREE (3) general factors that affect the ESR settling rate. (3 marks)

c. List THREE (3) clinical significances that end up with decrease ESR rate. (3 marks)

d. State the PCV reference range for adult male. (2 marks)

5. Based on haematological results given, shows the calculation of mean cell volume.

Hematological test

Result

Haemoglobin concentration 13.5 g/dL

RBC count 5.5 x 1012/L

Hematocrit /PCV 55% or 0.55 L/L

(3 marks)

PART C: ESSAY QUESTIONS (30 marks)

Answer THREE (3) questions ONLY.

Question 1

Write FIVE (5) common problems occur in preparing the blood smear using Push slide method. (10 marks)

angle too large or small

drop of blood too large or small

spread in jerky manner

failure to keep entire edge of spreader slide against slide

failure to push spreader slide completely across the slide

edges of spreader dirty or chipped or dusty

Question 2

With an aid of hemagrid, explain the procedure of white blood cell count using Neubauer chamber method. (10 marks)

Question 3

Write the packed cell volume method and illustrate the capillary result produced. (10 marks)

Question 4

With a formula, explain the red blood cell indices of MCH and MCHC and give their purposes in RBC determination. (10 marks)

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Hematology I MCQS

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