MLT GlobeHematology: WBC morphology & differential – page 6
109 Hematology MCQs on WBC morphology & differential with answers and explanations.
About half of the neutrophils inside blood vessels are loosely attached to vessel walls and are not counted in a blood sample. This group is called the:
Intravascular neutrophils are split into circulating and marginating pools of about equal size. Stress or exercise moves marginated cells into circulation and raises the count.
Lactoferrin is a component of which neutrophil granules?
Lactoferrin is a marker of the secondary (specific) granules, which appear at the myelocyte stage. Dense and alpha granules belong to platelets.
A smear shows heavy dark granules in neutrophils. Which finding favors Alder-Reilly anomaly over toxic granulation?
Alder-Reilly granules appear in all leukocytes and persist without infection. Döhle bodies, vacuoles and a left shift accompany toxic granulation in sepsis.
Inherited Pelger-Huët anomaly results from a mutation in the gene for:
Pelger-Huët anomaly is caused by LBR (lamin B receptor) mutations, which impair nuclear segmentation. MYH9 relates to May-Hegglin anomaly.
Many smudge cells prevent an accurate differential in a CLL patient. What step can reduce them?
Mixing blood with albumin stabilizes fragile lymphocyte membranes and reduces smudging. Delay would increase cell damage.
In marrow from a child recovering after chemotherapy, flow cytometry shows many CD19+, CD10+, TdT+ cells forming a smooth maturation pattern to CD20+ cells. These are most likely:
Hematogones are normal B-cell precursors that show an orderly continuum of antigen maturation. Leukemic blasts show a clustered, aberrant pattern without maturation.
A neutrophil containing a large, homogeneous, pale purple mass that pushes its nucleus aside is seen in a smear from synovial fluid. This is:
The LE cell is a neutrophil that has engulfed denatured, homogeneous nuclear material, linked to lupus. A tart cell is usually a monocyte that has ingested a whole nucleus that still shows chromatin pattern.
A cell in the monocyte series has a large, folded nucleus with fine chromatin and one or two nucleoli, and grey-blue cytoplasm with fine azurophilic granules. It is a:
Promonocytes show nuclear folding with fine chromatin and nucleoli, and are counted as blast equivalents in AML with monocytic differentiation. Mature monocytes lack visible nucleoli.
In a manual differential, the technologist counted 100 cells and found 2 eosinophils. To improve the precision of the differential, the best approach is to:
Differential counts follow a binomial distribution, so counting more cells reduces imprecision, especially for low-frequency cells. The feathered edge gives distorted and unevenly distributed cells.