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HAM711S - HAEMATOLOGY 3 - 2ND OPP - JULY 2023 |
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nAmlBIA UnlVERSITY
OF SCIEnCE Ano TECHnOLOGY
FACULTY OF HEALTH, APPLIED SCIENCES AND NATURAL RESOURCES
SCHOOLOF HEALTHSCIENCES
DEPARTMENTOF CLINICALHEALTHSCIENCES
QUALIFICATION: BACHELOROF MEDICALLABORATORYSCIENCES
QUALIFICATIONCODE: 0SBMLS
LEVEL:7
COURSECODE:HAM711S
COURSENAME: HAEMATOLOGY 3
SESSION:
JULY 2023
PAPER:
THEORY
DURATION: 3 HOURS
MARKS:
122
SECOND OPPORTUNITY EXAMINATION QUESTION PAPER
EXAMINER(S)
MS MARIEN NAUDE
DR MAURICE NYAMBUYA
MODERATOR:
DR AARON MARAMBA
INSTRUCTIONS
1. Answer ALL the questions.
2. Write clearly and neatly.
3. Number the answers clearly.
PERMISSIBLE MATERIALS
1. Pen
2. Calculator
THIS QUESTIONPAPERCONSISTSOF 9 PAGES(Including this front page)
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SECTION A (61 MARKS)
Question 1
[10x1=10]
Evaluate the statements below and select the most appropriate answer. Write only
the number and the correct corresponding letter on your answer sheet.
1.1 The combination of a prolonged APTTand a remaining prolonged APTTwith the
mixing study procedure indicates the presence of:
(1)
A) circulating inhibitor
B) factor VIII deficiency
C) anti-platelet antibodies
D) Aspirin usage
1.2 Based on the following data, what is the most likely factor deficiency considering
the findings below?
(1)
PT prolonged
APTT normal
TT normal
A) Factor VIII
B) Factor VII
C) Factor IX
D) Factor V
1.3 What During platelet adhesion, VWF binding to GPlb triggers intracellular signaling
and the activation of:
(1)
A) GP11b/111 on the platelet membrane which then binds soluble fibrinogen
B) GP111b/11 on the platelet membrane which then binds soluble fibrinogen
C) GP11b/111 on the platelet membrane which then binds soluble fibrin strands
D) GP111b/11 on the platelet membrane which then binds soluble fibrin
degradation products
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1.4 Which test is used to monitor Warfarin therapy?
(1)
A) Bleeding time
B) Factor Assays
C) Prothrombin Time
D) Activated Partial Thromboplastin Time
1.5 Which test is used to monitor the Intrinsic pathway?
(1)
A) Fibrinogen
B) DDimer
C) Prothrombin Time
D) Activated Partial Thromboplastin Time
1.6 The following leukemia is associated with Smudge Cells?
(1)
A) Acute Lymphoblastic Leukaemia (L3)
B) Prolymphocytic T cell Leukaemia (PTLL)
C) Chronic lymphocytic Leukaemia (CLL)
D) Acute Promyelocytic Leukaemia (M3)
1.7 A distinctive feature seen in Burkitts Lymphoma is:
(1)
A) L2 blasts which are large heterogenous cells
B) Vacuolated blasts
C) Convoluted nucleoli blasts
D) Faggot cells
1.8 The following cells were seen on the peripheral smear of a patient who presented
with lymphadenopathy, splenomegaly, and night sweats. What are the cells called?
(1)
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A) Plasma cells
B) Buttocks cells
C) Reed-Sternberg cells
D) Burkitt's lymphoma cells
1.9 What is the leukaemia in question 1.8 called, containing these diagnostic cells?
(1)
A) Prolymphocytic T cell Leukaemia (PTLL)
B) Acute Lymphoblastic Leukaemia (ALL-L3)
C) Adult T cell Leukaemia (ATLL)
D) Mantel Cell Leukaemia (MCL)
1.10 Which leukemia consist of flowery pleomorphic lymphocytes of which the
nucleus is convoluted and polylobed, often resembling a clover leaf or flower?
(1)
A) Prolymphocytic T cell Leukaemia (PTLL)
B) Acute Lymphoblastic Leukaemia (ALL-L3)
C) Adult T cell Leukaemia (ATLL)
D) Mantel Cell Leukaemia (MCL)
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Question 2
[28]
Read the below case study and answer the questions following.
A 5-year-old boy was admitted in the Katutura State hospital with complaints of regular
nose bleeds, lymphadenopathy, night sweats, severe fatigue, hepatomegaly and easy
bruising. The Lactate Dehydrogenase of the patient came out 10801U/L which is very high.
The FBCwas analyzed (table 1), a peripheral smear (image 1) and a manual differential
count (table 1) was performed:
FBC:
Rbc
4.80 X 1012/1 Neutrophils
10%
Hb
4.2 g / di
Lymphocytes
2%
Hct
42.4%
Monocytes
0%
MCV 88.3 fl
Eosinophils
0%
MCH 29.7 pg
Basophils
0%
MCHC 33.6 g/dl
Abnormal cells
88%
WBC
150.8 x 109/I
(pictured below): Blasts
Platelets
58 X 109/1
Table 1
Image 1
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2.1) Which leukemia is this patient most probably suffering from?
(1)
2.2) Describe the clinical, physical, white cell differential and the blood film results
that would be consistent with the above diagnosis.
(15)
2.3) Which further testing types will you perform to confirm your diagnosis?
(5)
2.4) The lmmunophenotyping results of the patient's bone marrow aspirate came back
from the Flowcytometry lab. Examine the results in image 2 and clearly explain
the outcome of the results associated with this type of malignancy.
(7)
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Image 2
Question 3
[23]
Read the below case study and answer the questions following.
A 52-year-old male presented at Mediclinic Hospital Casualty with a massive
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splenomegaly and had few lymph nodes which were swollen. The doctor requested
for a Full Blood Count (table 2) and Peripheral smear (image 3):
FBC:
Rbc
Hb
Hct
MCV
MCH
MCHC
WBC
Table 2
4.80 X 1012/1
8.2 g I di
Neutrophils
Lymphocytes
42.4%
Monocytes
88.3 fl
Eosinophils
29.7 pg
Basophils
33.6 g/dl
Immature cells
(Image 3)
Prolymphocytes
120.8 x 109/I Platelets
6%
13%
1%
0%
0%
80%
105 X 109/1
Peripheral smear:
Image 3
3.1) Examine the above results and suggest which of the haematological disorder the
patient is most likely to be suffering from. Motivate your answer.
(10)
3.2) Name at least six lmmunophenotyping markers which you would run to
confirm your diagnosis, and what are the expected results of each marker?
(6x2=12)
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Note: (1 mark per correct marker and 1 mark for the correct result)
3.3) Why is the prognosis poor in this type of haematological disorder?
(1)
SECTION B (35 MARKS)
Question 4
[35]
The Prothrombin Times (PT) of two patients are given in table 3.
Patient 1
Patient 2
Control
11.8 seconds
11.95 seconds
PT
24 seconds
12.89 seconds
Table 3
4.1) Of each patient, discuss the findings, possible clinical causes and which tests would
you proceed to confirm the possible clinical causes if any:
(9)
4.2) What does INR stand for?
(2)
4.3) What is the normal range for INR?
(2)
4.4) Calculate the INR for Patient 1 and Patient 2 if the ISi value is 1.3
(6)
4.5) Indicate on Patient 1 and Patient 2 if their INR is low, normal, or prolonged
(2)
4.6) Taking into assumption Patient 1 is on Warfarin therapy. What is the normal
therapeutic range for an INR and comment if patient l's Warfarin should be
adjusted.
(2)
4.7) If a sample fails to clot, what action will you do?
(2)
4.8) List the clinical conditions that could indicate the need for Warfarin therapy.
(6)
4.9) Which test do you use to monitor Heparin therapy and which pathway does it test for? (2)
4.10) Which anticoagulant tube do you use for coagulation and what is the ratio of blood
to anticoagulant?
(2)
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SECTIONC (26 MARKS)
Question 5
[6]
State whether the following statements regarding External Quality Assurance (EQA) are:
True (T) or False (F)
(6X1=6)
5.1) EQAis used to assessaccuracy
5.2) EQA is used mainly to assess reproducibility
5.3) Bias or systematic errors will be apparent
5.4) EQAimproves the accuracy and diagnostic usefulness of test methods
5.5) EQAsamples should be treated with great care and should be analyzed by the
most skilled technologist who is meticulous in his/her technique
5.6) EQA results should not show imprecision, as this should have been sorted out
by Internal Quality Control (IQC} before it became a problem
Question 6
[20)
Upon entering the laboratory, you come across a very angry Doctor who was complaining.
that his ICU patient's coagulation D-Dimer result is not out yet, however, he mentioned.
the Chemistry results were called to him already. In detail describe step by step how you
will go about handling this client complaint as per Standard Operating Procedures.
[THE END TOTAL:122 marks]
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