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HAM621S - HAEMATOLOGY 2B - 1ST OPP- NOV 2022 |
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nAmlBIA UnlVERSITY
OF SCIEnCE Ano TECHnOLOGY
FACULTYOF HEALTH,APPLIEDSCIENCESAND NATURALRESOURCES
DEPARTMENT OF HEALTH SCIENCES
QUALIFICATION: BACHELOR OF MEDICAL LABORATORY SCIENCES
QUALIFICATION CODE: 08BMLS
LEVEL: 6
COURSE CODE: HAM621S
COURSE NAME: HAEMATOLOGY 2B
SESSION: NOVEMBER 2022
DURATION: 3 HOURS
PAPER: THEORY
MARKS: 100
EXAMINER(S)
MODERATOR:
FIRSTOPPORTUNITY EXAMINATION PAPER
DR MAURICENYAMBUYA
DRELZABEVAN DERCOLF
INSTRUCTIONS
1. Answer ALL the questions.
2. Write clearly and neatly.
3. Number the answers clearly.
PERMISSIBLEMATERIALS
1. Pen
2. Calculator
THIS QUESTION PAPER CONSISTS OF 9 PAGES (including this front page)
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SECTIONA [SO]
QUESTION 1
Select one correct answer to each questions below.
1.1 Which cytogenetic changes are expected to be seen in order to confirm a
diagnosis of chronic phase of chronic myeloid leukemia {CML)?
{a) t{8;21){q21.3;q22)
{b) inv{16){p13.1q22)
{c) t{9;22){q34;q11.2)
{d) del{S){q13q33)
[20]
{1)
1.2 Various diagnostic procedures may be used to confirm a diagnosis of AML or
to determine if the disease has spread beyond the bloodstream. Which of the
following is often used to confirm a diagnosis of AML?
{a) Bone marrow examination
{b) Computed tomography {CT)of the chest
{c) Ultrasonography of the abdomen
{d) Magnetic resonance imagery {MRI) of the brain
{1)
1.3 The first phase of treatment in patients with AML is usually chemotherapy. Its
goal is to destroy as many leukaemia cells as possible and put the patient into
remission. Which of the following is a treatment that is sometimes given to
patients with AML in remission but at risk of relapse?
{a) Radiation therapy
(b) Speen transplantation
(c) Stem cell transplantation
{d) Surgery
{1)
1.4 What are the three driver mutations associated with myeloproliferative neoplasms
{MPNs)?
{a) JAK2, FLT3and IDH1
{b) JAK2, MPL and CALR
{c) MPL, TP53, and JAK2
{d) FLT3, MyC and RAS
(1)
1.5 Myeloproliferative neoplasms are a result of a{n) ___
pathway?
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JAK-STATsignalling
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(a) Inhibited
(b) Deformed
(c) Overreactive
(d) Normal functioning
(1)
1.6 Normal cells require signal molecules called ______
(a) Mitogens
(b) mRNA
(c) Growth factors
(d) Growth inhibitors
in order to grow.
(1)
1.7 ________
regulate the activation of genes in a cell.
(a) Signal transducers
(b) Cancer cells
(c) Transcription factors
(d) Enzymes
(1)
1.8 Mitosis (M) is immediately followed by ____
when the cell grows and
prepares for the next phase.
(a) Gap 1
(b) Synthesis
(c) Gap 2
(d) None of the above
(1)
1.9 Proteins that behave like the accelerator on a car and urge cells to go ahead
and divide quite precisely are called _______
_
(a) Oncogenes
(b) Tumour supper genes
(c) Proto-oncogenes
(d) Alleles
(1)
1.10 Genes that act in a manner analogous to the brakes in a car telling the cell, "no,
don't divide" are called _______
_
(a) Tumor Suppressor genes
(b) Oncogenes
(c) Proto-o ncongenes
(d) Alleles
(1)
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1.11 What does Essential thrombocythemia, Chronic myeloid leukaemia and
Polycythaemia vera have in common?
(a) Transform to AML
(b) Transform to ALL
(c) They are all MOS diseases
(d) Transform to IMF
(1)
1.12 Which one of the following is considered a hallmark of Essential Thrombocythemia?
(a) Very low platelets count
(b) Abnormally small platelets
(c) Extremely high and large agranular platelets
(d) Splenomegaly and bleeding or thrombosis
(1)
1.13 The following results were obtained on a sample of blood analysed in the
haematology laboratory. White cell count: 6.3 x 109/1, Neutrophils: 28%, Band cells:
33%, metamyelocytes 8%, lymphocytes: 25%, Monocytes: 6 %. How would you
describe this blood picture?
(a) Leukaemoid reaction
(b) Left shift
(c) Leucoerythroblastic blood picture
(d) Leucocytosis
(1)
1.14 Which one of the following statements is correct with regards to epigenetics?
(a) Genes which regulate the rate at which cells divide and die.
(b) Genes which regulate the process of transcription
(c) The heritable changes in gene expression due to the chemical composition
of the DNA.
(d) The inactivation of certain genes due to mutations which lead to increased
proliferation and decreased apoptosis.
(1)
1.15 A patient has a platelet count of 700 x 109/1.The platelets are abnormal in size,
shape and granularity. The white cell count is 12 x 109/1and the haemoglobin is
llg/dl. There is no Philadelphia chromosome. Which of the following is the most
likely diagnosis:
(a) Leukaemoid reaction
(b) Polycythaemia Vera
(c) Essential Thrombocythemia
(d) Myelofibrosis
(1)
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Determine whether the following statements are True or False. Only select the correct letter
(a/b) corresponding to your answer.
1.16 The diagnosis of myeloproliferative neoplasms (MPNs) is made exclusively by
laboratory assessment.
(a) True
(b) False
(1)
1.17 The majority of myelodysplastic syndrome cases can be linked to specific
environmental risk factors.
(a) True
(b) False
(1)
1.18 Acute Myeloid Leukaemia (AML) French American British (FAB) classification MSa
is a monocytic leukaemia with differentiation.
(a) True
(b) False
(1)
1.19 A patient with myelofibrosis is not likely to develop acute leukaemia due to the
high platelet count.
(a) True
(b) False
(1)
1.20 Physiologically, co4+ count is twice the amount of cos+ count.
(a) True
(b) False
(1)
QUESTION 2
[30]
A 69-year-old female was seen in the clinic for dizziness, lethargy and weakness and on
examination she was found to have a large spleen. A bone marrow biopsy showed
megakaryocytes that cluster around the marrow sinusoids. The results of her blood
count was as follows:
WBC: 16.lx 109/1
RBC: 5.8 X 10 12/1
Hb: 23g/dl
Pits: 478x 109/1
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2.1 Which disorder is compatible with the case study above? Give reasons for your
answer and state the gene mutation present.
(4)
2.2 Predict if the serum B12 and erythropoietin levels will be decreased, normal or
increased in this condition.
(1)
2.3 In which of the four myeloproliferative disorders is the gene found in the above
disorder not present?
(1)
2.4 Referring to your answer in 2.3, which cytogenetic abnormality does it have, and
which genes are involved?
(4)
2.5 Discussthe laboratory tests and the expected results in the disorder in 2.3.
Include FBC,peripheral blood smear, immunophenotyping and cytochemical
staining.
(10)
2.5 Identify the AML using FABclassification that is best described by each of the
following FAB/WHO descriptions below: (2 marks for each correct answer).
(10)
2.5.1
2.5.2
2.5.3
2.5.4
2.5.5
Slide: increased eosinophils, hypersegmented with large abnormal granules,
blasts with/out Auer rods, monocytes increased, SB/ MPO >3% +, CD33+,
CD13+,CDllb+, FISH/PCR:lnv(16;16)
Slide: Blasts are pleomorphic, Bizarre platelets, bare nuclei, micro-
megakaryoblasts, Dry tap: Fibrosis, MPO+,SB-, CD41+, CD42+,CD61+
Slide: increased myeloblasts, Auer rods+/-, monocytes <1%, ~3% + with SBor
MPO, lmmunophenotyping: CD117+,MPD
Slide: Monocytes + Promonocytes {25 -75%), MPO -, CDllb+, Increased
muramidase
Slide: increased in both myeloid and erythroid precursors, BM: erythroblasts
>50% of all nucleated cells, Iron laden mitochondria and ferritin molecules
with electron microscopy, CD13+,CD33+,+ transferrin receptor
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SECTION B [SO]
QUESTION 3
[20]
A 57-year-old male presented with anaemic symptoms and easy bruises. The following
karyotypic results were obtained.
1) IfI \\1
2
,r )•''i IJ.
II
1
B
H )(
)
"
J,f
ii
'"
I..I
n "''
if t fl I 1- Ii
il
t•
is
te
II
1r
-~ 81 aa
io
Iii '"
)I
&i JL
).t
)(
V
3.1 Mention the myelodysplastic disorder that the karyotype result is associated
with.
(2)
3.2 Describe the laboratory features of this disease.
(8)
3.3 Myelodysplastic syndrome (MDS) is a heterogeneous group of disorders which have
certain features in common. Describe and discuss the pathogenesis of MOS.
(5)
3.4 Match the sentence in column A with the appropriate sentence from column B. (5)
Column A
Column B
3.4.1 Child with whooping cough A
3.4.2 Marked bacterial infection B
Leucocytosis with a left shift
Thromboctosis with small, normal platelets
3.4.3 Infectious Mononucleosis
3.4.4 Bone Marrow infiltration
C Lymphocytosis with smear cells
D Leuco-erythroblastic reaction with tear-drops
poikilocytes
3.4.5 Marked blood loss
E Lymphocytosis with activated lymphocytes++
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QUESTION 4
[30]
A 58-year-old man had been complaining of progressive tiredness for many months. Recently
he had noticed that he was bruising easily and was experiencing night sweats. A physical
examination by the doctor revealed that he had hypertension, a slight fever and an enlarged
spleen. A full blood count, differential count and a LAPscore test were requested.
Full blood count
White Cell Count
Red Cell Count
Haemoglobin
Platelets
22.7
3.6
10.8
600
X109/I
x10 12;1
g/dl
X109/I
Peripheral blood smear
Differential count
Neutrophils
Band cells
Metamyelocytes
Myelocytes
Promyelocytes
Eosinophils
Basophils
Lymphocytes
Monocytes
Blasts
nRBCs
38%
13%
9%
10%
2%
1%
1%
21%
3%
2%
10%
4.1 Correct the white cell count (show all calculations).
(4)
4.2 The total cell numbers were as follows; A=90; B=S; C=3;D=2 and E=0. Calculate
the LAP score (show all calculations).
(7)
4.3 Based on your LAP score above, what is most likely to be the diagnosis for this
patient?
(2)
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4.4 Name other condition in which the LAPscore is useful and the expected score
value.
(2)
4.5 State the Coulter principle and describe its use in haematology automation.
(10)
4.6 The heterophile antibody test (monospot) is used in the diagnosis of
mononucleosis. Describe the test and state its principle.
(5)
End of Examination
Total Marks: [100]
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