Question 1

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

Accepted Answer

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

Question 2

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

Accepted Answer

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

Question 3

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

Accepted Answer

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

Question 4

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

Accepted Answer

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

Question 5

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

Accepted Answer

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

Question 6

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

Accepted Answer

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

Question 7

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

Accepted Answer

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

Question 8

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

Accepted Answer

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

Question 9

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

Accepted Answer

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

Question 10

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

Accepted Answer

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

Question 11

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

Accepted Answer

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

Question 12

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

Accepted Answer

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

Question 13

Name one way that the laboratory verifies/validates the following:
A)Accuracy
B)Precision
C)Analytical sensitivity
D)Analytical specificity

Accepted Answer

Accuracy: quality control material
Preci

Question 14

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

Accepted Answer

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

Question 15

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

Accepted Answer

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

Question 16

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

Accepted Answer

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

Question 17

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

Accepted Answer

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

Question 18

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

Accepted Answer

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

Question 19

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

Accepted Answer

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

Question 20

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

Accepted Answer

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

Exam 40: Quality Assessment in the Hematology Laboratory

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

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

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

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

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

The following CBC results were obtained on an adult female: RBC 3.05\times1/ WBC 8.1\times1/ 6.4/ PLT 412\times1/ 23\% 75 21 28/ Which is the most appropriate action?

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

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

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

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

Name one way that the laboratory verifies/validates the following: A)Accuracy B)Precision C)Analytical sensitivity D)Analytical specificity

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

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

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

Given the following precision study results for an automated prothrombin time procedure: Precision Study Level 1 Level 2 Level 3 Mean 10.5 12.1 19.4 SD 0.06 0.18 0.17 CV 0.6\% 1.5\% 0.9\% Manufacturer's CV 0.8\% 1.1\% 1.1\% Which is the appropriate interpretation?

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

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

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

Introduction

Cellular Homeostasis

Hematopoiesis

Structure and Function of Hematopoietic Organs

The Erythrocyte

Hemoglobin

The Leukocyte

Introduction to Anemia

Anemias of Disordered Iron Metabolism and Heme Synthesis

Hemoglobinopaties: Qualitative Defects

Thalassemia

Megaloblastic and Nonmegaloblastic Macrocytic Anemias

Introduction to Hemolytic Anemia

Hemolytic Anemia: Membrane Defects

Hemolytic Anemia: Enzyme Deficiencies

Hemolytic Anemia: Immune Anemias

Hemolytic Anemia: Nonimmune Defects

Nonmalignant Granulocyte and Monocyte Disorders

Nonmalignant Lymphocyte Disorders

Introduction to Hematopoietic Neoplasms

Myeloproliferative Disorders

Myelodysplastic Syndromes

Acute Myeloid Leukemias

Acute Lymphoblastic Leukemias

Lymphoid Malignancies: Chronic Lymphoid Leukemias, Lymphomas, and Plasma Cell Neoplasms

Hematopoietic Stem Cell Transplantation

Morphologic Analysis of Body Fluids in the Hematology Laboratory

Primary Hemostasis

Secondary Hemostasis and Fibrinolysis

Disorders of Primary Hemostasis

Disorders of Secondary Hemostasis

Thrombophilia

Hematology Procedures and Hemostasis

Bone Marrow Examination

Automation in Hematology and Hemostasis

Flow Cytometry

Chromosome Analysis of Hematopoietic and Lymphoid Disorders

Molecular Analysis of Hematologic Diseases

Laboratory Testing in Coagulation

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