2015

 LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  

Week 4 - PROBLEM SET ( 200 points )

INSTRUCTIONS: Report all numerical answers to 1 decimal place. Do not round values
used for calculations. Must show calculations and units full credit.
**Remember to attach signed lab safety sheet! 2 points will be deducted if not attached.**
(1) A standard curve for hemoglobin (HgB) yielded the equation y = 0.049x + .004 (with an r2 value of
.998 over the range of 0 - 50 g/dl HgB. Using the equation from this standard curve line equation,

a) Determine the HgB values for the patient samples to fill in the table below. (15 points total)

Patient Absorbance HgB calculation HgB conc. Hct

(540 nm) (g/dL) (%)
1 (Female) 0.383 37.2

2 (Female) 0.646 38.4

3 (Male) 0.621 41.7

4 (Male) 0.745 42.4

5 (Pregnant) 0.586 30.4

b) Is patient #1 anemic ( yes / no )
Is patient #2 anemic ( yes / no )
Is patient #3 anemic ( yes / no )
Is patient #4 anemic ( yes / no )
Is patient #5 anemic ( yes / no )
based on: low Hct / low HgB / both normal
based on: low Hct / low HgB / both normal
based on: low Hct / low HgB / both normal
based on: low Hct / low HgB / both normal
based on: low Hct / low HgB / both normal

(2) Which of the statements is/are true concerning determination of Hct and HgB ? (2 pts)
a) the colorimetric assay for HgB uses alkaline potassium ferricyanide to oxidize hemoglobin
to methemoglobin
b) Hct is determined by dividing the total blood volume (or height) in the hematocrit tube by
the packed red blood cell volume (height)
c) A blood sample with a large proportion of lysed (broken) cells will still give an accurate Hct
d) a and b only
e) none of the above

(3) Which of the following conditions can present with low MCV and low MCHC values? (2 pts)
a) Thalassemia
b) Iron deficiency
c) porphyrin defects
d) all of the above
e) a and b only
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  

(4-6) Using the values provided below, calculate the MCV, MCH and MCHC values for each patient
below. Calculate MCHC using Hgb and Hct for Patients A, B and C and using MCV and MCH for
patients D and E. Show your work and include units for full credit. (15 pts)

Patient Hct (%) HgB (g/dL) RBCs

A 34.6 7.8 4.97 x 1012
B 44.7 15.2 5.31 x 1012
C 36.7 13.0 4.54 x 1012
D 48.4 8.1 4.71 x 1012
E 33.7 6.8 5.02 x 1012

Patient A: MCV = _____________ MCH = ________________ MCHC = ________________

Patient B: MCV = _____________ MCH = ________________ MCHC = ________________

Patient C: MCV = _____________ MCH = ________________ MCHC = ________________

Patient D: MCV = _____________ MCH = ________________ MCHC = ________________

Patient E: MCV = _____________ MCH = ________________ MCHC = ________________

2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  

(7) Based on all data for each patient provided above (questions 4-6) fill in the table below (33 pts)

Cell Morphology Anemia ? Severity List 2 possible cause(s)

(based on)
Patient A
(female)

Patient B
(male)

Patient C
(male)

Patient D
(female)

Patient E
(male)

(8) A male patient has an MCV = 103.7 fL; RBC# of 4.82 x1012 and an MCH = 33.6 pg. (6 pts)
Based on these values, complete the questions below (show calculations and units)

What is his Hct value? _______________ What is his HgB value? ______________

Describe his RBC morphology ________________________________________________________

Is he anemic? ___________ Based on what indicator(s) ________________________________

(9) A female patient has normal MCV and normal MCHC values. However, her RBC concentration is
reduced and her Hct value indicates a severe anemia (4 pts)

In terms of RBCs, what is the fundamental problem that could account for this? ________________
_________________________________________________________________________________
_________________________________________________________________________________

Describe two causes of anemia (or types of conditions) that present this way.
_________________________________________________________________________________
_________________________________________________________________________________
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  
(10) Ann, a 21 year old female patient, presents with nausea, fatigue, edema of the feet and ankles, and
has the following CBC values: Hct = 34.8% RBCs= 4.23 x1012 HgB = 12.3 g/dl
What are Ann’s MCV and MCHC values? (Show calculations and units) (8 pts)

MCV = __________________ MCHC = __________________

Is she anemic? ___________ Based on what indicator(s) ________________________

Describe (classify) her RBC morphology _______________________________________________

List/ describe a likely cause for her condition ______________________________________

Would this condition change your interpretation of her CBC values? How? __________________________

_________________________________________________________________________________________________

(11) Jack, a 43 year old male patient, is recovering from surgical removal of an aggressive, but benign,
intestinal tumor 6 days ago. He has recently complained of light-headedness and extreme fatigue.
His current CBC values are: Hct = 37.7% RBCs = 3.81x1012 HgB = 12.4 g/dl
What are Jack’s MCV and MCHC values? (Show calculations and units) (9 pts)

MCV = __________________ MCHC = __________________

Is he anemic? _____________ Based on what indicator(s) __________________________

Describe his RBC morphology ________________________________________________________

List/ Describe a possible cause: _________________________________________________________

________________________________________________________________________________________________

________________________________________________________________________________________________

(12) A patient has the following CBC results: MCV = 81.18 fL RBCs = 4.73x1012/L MCH = 24.52pg
Based on these values, which of the following is correct? (2 pts)
a) Hct = 17.16% HgB = 51.84 g/dl
b) Hct = 21.14% HgB = 28.44 g/dl
c) Hct = 38.40% HgB = 11.60 g/dl
d) Hct = 21.14% HgB = 11.60 g/dl
e) Hct = 31.17% HgB = 28.44 g/dl
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  
(13) A patient has high MCV and high MCHC values. (5 pts)

List their possible or likely RBC morphology _____________________________________________

This could be indicative of what causes of anemia (list 2) ____________________________________
Based on only the data provided, is the patient anemic? _____________________________________

(14) A non-pregnant 23 year old female patient had blood work done over a successive period of several
months which yielded the following data (today = day 90): (13 pts)

Day 01 HgB = 13.2 g/dl Hct = 39.2% RBCs= 4.31 x1012

Day 15 HgB = 13.1 g/dl Hct = 38.4% RBCs= 4.13 x1012
Day 30 HgB = 12.5 g/dl Hct = 36.3% RBCs= 3.68 x1012
Day 45 HgB = 12.1 g/dl Hct = 35.3% RBCs= 3.22 x1012
Day 60 HgB = 12.0 g/dl Hct = 34.4% RBCs= 2.91 x1012
Day 75 HgB = 12.0 g/dl Hct = 34.3% RBCs= 2.61 x1012
Today HgB = 11.8 g/dl Hct = 34.1% RBCs= 2.60 x1012

Given the data above, is she anemic? ___________ Based on what/which indice(s)? _______________

Over-time (Day1 to today), what has been the change in her MCV? _____________________________

in her MCH? _________________________________________________

in her MCHC? _________________________________________________

Note: report change in indicator’s units and directionality of change (e.g. increased 2.0 fL or decreased 10 pg)

What is her current RBC morphology? ____________________________________________________

What type(s) of anemia is this indicative of? ________________________________________________

(15) Two non-pregnant female patients have the following values:

Jane - Hct = 34.7%; Mary – HgB = 13.7 g/dl.
Based on these values, which of the following is/are correct? (2 pts)
a) if both have identical RBC # (4.27x1012), then only Mary is anemic
b) if both have identical RBC # (as above), then only Jane has macrocytic cells
c) if both have identical RBC # (as above), then Mary will exhibit microcytic cells if she
has a Hct value <33.9%
d) a and b only
e) none of the above
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  

(16) Two males (Max and Bob), have identical numbers of RBCs (4.88x 1012) and identical MCHC
values (32.4g/dl). Based on these data, which of the following is/are correct? (2 pts)
a) if Max has a Hct = 39.7% and Bob has a Hct = 41.5, then Bob has the lowest HgB value
b) if Max and Bob have the Hct values above, then only Max would have microcytic cells
c) if Max and Bob have the Hct values above, then only Max is anemic
d) a and b only
e) none of the above

(17) Having developed a new assay for HgB and established the new assays’ validity in lab settings, you
will now be testing the assay under field conditions and will be confirming and following up on 6 non-
pregnant females who gave Anemic HgB values in a study conducted 6 weeks ago using a different
(“old”) assay. Given below, are data for the 6 Anemic subjects (replicate results), and triplicate results for
an established HgB Standard [ 14.0 g/dL ]. Based on these data, answer the questions that follow. (21 pts)

Subjects: AA DD GG RR KK WW STD

New Assay 11.7/11.3 10.5/11.1 13.4/12.8 10.1/9.3 8.8/9.4 13.7/14.3 15.0/14.8/15.5

Old Assay 10.2/9.4 9.6/8.1 10.0/11.4 8.1/6.9 7.8/6.2 10.5/9.1 13.0/13.8/14.5

Calculate the Mean HgB for each

AA DD GG RR KK WW STD

New ________ ________ ________ ________ ________ ________ __________

Old ________ ________ ________ ________ ________ ________ __________

Which assay is more precise based on the values for the standards (show work)? ________________

Which assay is more accurate? ________________

Which (if any) diagnoses have changed as a result of the new vs old assay? _______________________

____________________________________________________________________________________

Which assay (“old” or “new”) would you use for the next, large-scale study and why would you use it?

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  
(18) A non-pregnant 26 year old female returned 13 weeks ago from a 10 month period as a Peace Corps
worker in remote South America. Shortly after her return, she was diagnosed with anemia and began
treatment. Since then, she has been monitored to assess the progress of her recovery. Evaluate her
situation given the blood work data presented below [fill-in the missing data first: Round to 1 decimal
point]. (35 pts)

Hct(%) HgB(g/dL) RBC # MCV(fL) Std DevMCV MCH(pg) MCHC(g/dL) RDW(%)

12
Day 01 30.4 7.92 4.13x10 73.61 12.38 19.18 26.05 16.82
12
Day 07 29.8 7.86 4.10x10 72.68 11.47 19.17 26.38 15.92
(treatment started) ---------------------------------------------------------------------------------------------------------

Day 14 29.5 7.73 4.09x1012 ______ 13.58 18.90 ______ 18.82

Day 28 30.2 7.88 4.10x1012 73.66 13.74 ______ 26.09 ______

Day 56 31.7 8.21 4.12x1012 ______ 14.52 19.93 ______ ______

Day 70 33.3 10.61 4.14x1012 ______ 15.53 ______ ______ 19.31

Day 84 34.2 11.25 4.14x1012 82.61 14.67 ______ 32.90 ______

(Today)

At the start of her treatment (day 14): Describe her cell morphology
____________________________________

Was her RDW normal ? ___________ Was she anemic? ___________

Based on what indicator(s) _______________________________________

Today (day 84): Describe her cell morphology ______________________________________________

Is her RDW normal ? ___________ Is she anemic? ___________

Based on what indicator(s) _______________________________________

Is the treatment working? ___________ Are ALL the RBC indices within normal limits? _________

Which (if any) indices are NOT? ________________________

For any values that are NOT within normal limits, explain/discuss the trends of those indices AND
possible reasons why they are outside the normal range(s)
____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  

(19) Upon admission to the hospital, blood analysis on a 32 year old male patient provided the following
data: Hct (%) = 28.3 HgB (g/dL) = 9.1 RBCs (#) = 3.49 x x1012 RDW (%) = 12.2

What are his MCV and MCHC values? (Show calculations and units) (24 points)

MCV = __________________ MCHC = __________________

Is he anemic? ________ Based on what indicator(s) __________________ Severity? ___________

Describe his RBC morphology ________________________________________________________

Further test results (HIGH Blood Urea Nitrogen and HIGH Creatinine) revealed significant (>60%) loss of
renal function. Based on these results and those above, briefly discuss if/how this affects your
interpretation of the patient’s situation.
____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

Diet assessment revealed apparent sufficiency of all nutrients, and a synthetic form of Erythropoietin
(‘Procrit’) was administered. Now, 2 weeks after Procrit treatment, the following blood values were
obtained:
Hct (%) = 29.8 HgB (g/dL) = 9.6 RBCs (#) = 3.71 x x1012 RDW (%) = 12.4

What are his MCV and MCHC values now? (Show calculations and units)

MCV = __________________ MCHC = __________________

Is he anemic? ________ Based on what indicator(s) __________________ Severity? ___________

Describe his RBC morphology __________________________________________________________

Should he continue receiving Procrit treatment – why or why not? ______________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________
2015  LAB  4          Name:  _____________________________________________   Lab  TA:  _______________________________  

(20) 2 weeks after moving into the dormitories at the Colorado School of Mines (in the Rocky Mountains
about 20 miles east of Denver), all students had blood taken and analysis performed as part of a study.
Regarding the student blood samples, which of the following statements is/are true?
a) centrifuging the blood at too high a speed could artificially lead to a low Hct value
b) assuming similar ages, gender, diet and lifestyle, freshman coming from coastal communities of
California would be expected to have HgB values comparable to California students who have
lived in Denver area for the past 9-12 months
c) a student with significant hypernatremia would likely have decreased HgB and a decreased Hct
compared to their values in a normal natremic (normal sodium) state
d) all of the above
e) a and b only