nAmIB lA UnIVERSITY OF SCIEnCE AnD TECHnOLOGY

FACULTY OF HEALTH AND APPLIED SCIENCES

DEPARTMENT OF HEALTH SCIENCES

QUALIFICATION: BACHELOR OF BIOMEDICAL SCIENCES

QUALIFICATION CODE: SOBBMS LEVEL: 6

COURSE CODE: HAM210S COURSE NAME: HAEMATOLOGY 1

SESSION: JUNE 2016 PAPER: THEORY

DURATION: 3 HOURS MARKS: 100

FIRST OPPORTUNITY EXAMINATION QUESTION PAPER EXAMINER($) MR.MARTIN GONZO

MODERATOR: MR. MUNYARADZI MUKESI

INSTRUCTIONS 1. Answer ALL the questions. 2. Write clearly and neatly. 3. Number the answers clearly.

PERMISSIBLE MATERIALS

THIS QUESTION PAPER CONSISTS OF 7 PAGES (Including this front page} SECTION A [25]

MULTIPLE CHOICE QUESTIONS QUESTION 1 [20]

Answer ALL questions. Each correct answer is worth ONE mark.

1.1. Which of the following is TRUE for haemopoiesis? (1) a) In the first few weeks of development the long bones are the main site of haemopoiesis b) In adult life all the bone marrow is haemopoietic c) During childhood there is progressive fatty replacement of ma rrow in the long bones d) In adult life haemopoietic marrow is confined to the central skeleton only e) Red marrow forms only red blood cells

1.2. A full blood count was done and the results were as follow: red blood cells 2.86 X1012/L, red cell distribution width 23% and the mean cell volume 65 fl.

Select the expected morphologies for the above results: (1) a) Severe and b) Howell-Jolly bodies and anisocytosis c) Microcytes with anisocytosis d) with normal size red blood cells e) Microcytosis and target cells

1.3. Juvenile red blood cells are reticulocytes. When stained they have granules in the red cells and these stained aggregates are actually which of the following? (1) a) Siderocytes b) RNA c) DNA d) e)

1.4. Increased erythrocyte production rates are suspected in the following cases EXCEPT in which case not? (1) a) Haemolytic anaemia b) Sickling disease c) Megaloblastic anaemia d) Successfully treated iron deficiency anaemia e) Haemolytic disease of the newborn

1.5. What is the best description of a normoblast also called a late erythroblast? (1) a) 20-25 ｾｭ＠ diameter; Nucleus Comprises 80% of cell; Fine reticular appearance; 1 or 2 nucleoli; Light blue and becomes a darker royal blue with maturation. b) 10-15 ｾｭ＠ diameter; Nucleus comprises 25% of cell; Very dense, pyknotic nucleus with little or no chromatin structure visible; No nucleoli; Cytoplasm light pink to slightly blue-gray.

Page 2 of7 c) 13-16 11m diameter; Round to oval; Comprises 75% of cell; Chromatin clumped as "chromo-centers" of dark stain against a light red-violet background; 1 or 2 nucleoli; dark blue, occasionally with a reddish tinge resulting from the early production of haemoglobin. d) 12-15 11m diameter; Comprises 25%- SO% of cell; Very coarse, dark chromatin; No nucleoli; Blue-gray to pink-gray.

1.6. Which metabolic pathway generates 90% ofthe ATP needed by red blood cells? (1) a) Hexose Monophosphate Shunt b) Leubering-Rapaport Shunt or Pathway c) Methaemoglobin Reductase Pathway d) Embden-Meyerhof Glycolytic Pathway e) Hexose Reductase Pathway

1.7. If you have to define intravascular Haemolysis, which ofthe following would you choose? (1) a) The breakdown or red cells within the liver and spleen b) The breakdown of red cells within the bone marrow c) The breakdown of red cells within the circulation d) The breakdown of red cells in the RES system e) All of the above

1.8. Select the option providing the best explanation ofthe morphological abnormality in acquired sideroblastic anaemia: (1) a) Basophilic stippling and Heinz bodies b) Howell Jolly bodies and basophilic stippling c) Heinz bodies d) Howell Jolly bodies e) Pappenheimer bodies

1.9. associated with acute blood loss is characterized by: (1) a) Decreased reticulocyte count b) Decreased bone marrow activity c) Increased reticulocyte count d) Pancytopenia e) Macro-ovalocytes

1.10. Patients with Crohn's disease or celiac disease commonly develop a macrocytic anaemia due to: (1) a) Folate deficiency b) Mal-absorption of vitamin B12 c) Development of autoantibodies against intrinsic factor d) Increased blood cholesterol levels e) Vitamin B12 deficiency f)

Page 3 of7 1.11. Which erythrocyte inclusions are composed of aggregated, denatured haemoglobin and they stain with Supravital stains but not with Romanowsky stains? (1) a) Howell-Jolly bodies b) Pappenheimer bodies c) Sideroblasts d) Basophilic stippling e) Heinz bodies

1.12. Which of the following is the same as a helmet or bite cell? (1) a) b) Dacrocyte c) Plasmacyte d) Keratocyte e) Discocyte

1.13. A patient had a FBC done, the test results were: Haemoglobin 14.0 g/dl; red blood cells 4.5 x1012/L; haematocrit 39% and the white cell count 12.0 x109/L. What would the mean cell haemoglobin (MCH) be? (1) a) 24.2 pg b) 33.0 pg c) 31.1 pg d) 88.0 pg e) 28.1 pg

1.14. The reference range for an adult male of the mean corpuscular haemoglobin is: (1) a) 31-36 b) 27-31 c) 80-100 d) 4-11 e) 27-36

1.15. How would you correct the following statement? (1) a) Vitamin B12 is one type of microcytic anaemia. This anaemia is treated with oral B12, because no intrinsic factor is present. b) Vitamin B12 is one type of a macrocytic anaemia and this anaemia is treated with oral 812, because no intrinsic factor is present. c) Vitamin 812 is one type of a haemolytic anaemia and this anaemia is treated with oral 812, because the intrinsic factor is present. d) Vitamin 812 is one type of a microcytic anaemia and this anaemia is treated with injected 812, because the intrinsic factor is present. e) Vitamin 812 is one type of a macrocytic anaemia and this anaemia is treated with injected B12, because no intrinsic factor is present.

Page 4 of 7 1.16. Megaloblastic anaemia is associated with: (1) a) Ineffective erythropoiesis and increased reticulocytes b) Ineffective erythropoiesis and decreased reticulocytes c) Ineffective erythropoiesis and increased white blood cells d) Ineffective erythropoiesis and increased platelets e) Ineffective erythropoiesis and marked an isocytosis

1.17. Laboratory findings in most probably would be the following, EXCEPT: (1) a) Normochromic normocytic anaemia b) Howell jolly bodies present on the thin smear c) Increased relative reticulocyte count d) Pencil cells present on the thin smear e) Sickle cells present on the thin smear

1.18. It is possible to observe or reticula-cytopenia in certain conditions. Decide which condition out of the list below may initiate a reticulocytosis. (1) a) Chemotherapy b) Sickle cell anaemia c) Viral Parvovirus 819 infection d) Aplastic anaemia e) Vitamin 812 deficiency

1.19. A 21-year-old female is seen in the clinic with a main complaint of overwhelming tiredness and fatigue. Routine blood tests indicate the following results: (1) R8C 2.9 x1012/L Hgb 6.51 g/dl Hct 19.2% MCV 65.1 fl MCH 20.8 pg MCHC 29.0 g/dl How would you classify this patient's anaemia morphologically? a) Macrocytic, normochromic b) Microcytic, hypochromic c) Normocytic, normochromic d) Microcytic, normochromic e) Macrocytic, hypochromic

1.20. The most common clinical disorder resulting from an amino acid substitution in the globin chain is: (1) a) Haemoglobin C disease b) Sickle cell disease c) Thalassaemia d) Haemoglobin E disease e) Megaloblastic anaemia

Page 5 of7 QUESTION 2 [5]

2.1. Describe a target cell and give three disease where target cells are most likely found (5)

SECTION B [25] QUESTION 3 [19]

A 44 year old male has been feeling very weak and tired during last two months. His full blood count was done and a slide was made.

WBC: 5.5 x109/L RBC: 4.28 x10 12/L HGB: 9.7 g/dl HCT: 29.9 % MCV: fl MCH : 22.6 pg MCHC: 32.4 g/dl ROW: 22.4 % PLT: 460 x109/L ROW: 22% His blood smear: - "" I IVO 0 ｏ ｱｾﾷｄ＠ 0 Q. c;O 0 '() ( () ° 0 a oO 0 ..., o o o · · 0 . • C.· Q .... oor- o o 0 ()" o a .)o Q o 0 0 c; . 0 0 0 D o.-:). o 0 o 0 ' <:) 0 0 . 0 () _d'"'0 ..:?. 3.1. Calculate the MCV, show your calculations. (2)

3.2. Comment on the red cell morphology on the slide. (4) 3.3. What is your suggested diagnosis for this patient? (1) 3.4. List 4 causes for the suggested diagnosis. (4)

3.5. Why you think it is most likely to observe Hypersegmented neutrophils on the differential thin

smear of this patient? Why do you think so? (2)

3.6. Explain why the ROW support your suggested diagnosis for this patient. (2) 3.7. Which other laboratory tests would you suggest to confirm your diagnosis? (1)

3.8. What would the expected results be of your suggested laboratory tests? (3)

Iron deficiency a) Serum Iron

b) TIBC

c) Serum ferritin

Page 6 of 7 SECTION C [SO]

QUESTION 7 [25]

7.1. Describe the differential diagnosis for macrocytic anaemias. (25)

QUESTION 8 [25]

8.1. The haemostatic mechanism is a complex process involving 5 major components which are:

The vessel wall Platelets Plasma coagulation factors lnhibitos and Plasma fibrinolytic system. Discuss the role of each of the five components in coagulation. (25)

END OF PAPER

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