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Journal-based learning exercises: Cytopathology/Haematology


Journal-based learning (JBL) exercises are a regular feature of CPD coverage in The Biomedical Scientist. You may complete as many JBL exercises as you wish and are not restricted by specialty. Each article’s contents should be read, researched and understood and you should then come to a decision on each question. The pass mark is 17 out of 20 questions answered correctly. Journal-based learning exercises may be completed at any time until the published deadline date. Please select your choice of correct answers and complete the exercises online (www.ibms.org/go/practice-development/cpd/jbl).


DEADLINE: WEDNESDAY 3 AUGUST 2016


A normal colposcopy examination fails to provide psychological reassurance for women who have had low-grade abnormal cervical cytology. Cotton SC, Sharp L, Little J et al.; TOMBOLA Group. Cytopathology 2015; 26 (3): 178–87.


A The cohort completed the Hospital Anxiety and Depression Scale (HADS) and process outcome-specific measure (POSM) at 12, 24, 36 months.


B In England in 2010–2011 around 40% of women with low-grade cytology who underwent colposcopy had no visible abnormality.


C HADS is designed to assess specific issues relating to anxiety.


D Significant anxiety was defined as a HADS anxiety subscale score ≥15.


E Multivariate logistic regression was used to identify significant associations between sociodemographics.


F The majority (82%) had a previous BNA cytology test in the previous three years.


G 96% of eligible women completed the psychological questionnaire at recruitment.


H Response rates declined from 70% at 12 months to 66% at 30 months.


I Two-thirds were worried about having cervical cancer or their general health.


J 7% had depression at recruitment. The accumulative prevalence of depression during follow-up was 11%.


K The most prevalent worry was the result of the next cytology test (accumulative prevalence 71%).


L The results suggest that normal colposcopy does not provide psychological reassurance for a substantial proportion of women.


M A positive finding is that for many women these worries appeared to resolve by 18 months.


N At 30 months, 65 of the 479 questioned were worried about having cervical cancer.


O A possible explanation for the apparent persistence of adverse psychological effect is the fact that women were followed up on an annual basis.


P The Leventhal ‘common sense’ model of illness postulates that this phenomenon does not arise because of representations that patients hold of the ‘illness/condition’ and the test.


Q Studies show that an abnormal cytology test result is associated with significant adverse psychological sequelae.


R Women who have a normal colposcopy examination following one or more low-grade cytology tests have a low risk of diagnosis of CIN2/3 over three years.


S HPV triage in England means that the route by which women come to cytology will not change.


T Women’s knowledge and understanding of colposcopy are frequently poor.


Interference of blast cell fragments with automated platelet counting. Frotscher B, Salignac S, Muller M, Latger-Cannard V, Feugier P, Lesesve JF. Int J Lab Hematol 2015; 37 (5): 613–9.


Assessment No 050816 TRUE FALSE Assessment No 050416


A All three automated blood count analysers employed the same platelet counting principle.


TRUE FALSE


B Spurious increases in platelet counts have been related to platelet satellitism to polynuclear neutrophils.


C The study by Kim et al. (2010) did not reveal interference of non-platelet particles in any specimen studied.


TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE


D No correlation was found between pseudoplatelet numbers and circulating blast numbers.


E Platelet count overestimation due to blast cell fragments has been described in hairy cell leukaemia.


F Haemorrhagic diathesis in acute leukaemia can be related to thrombocytopenia but not platelet dysfunction.


G Platelet count overestimation due to the presence of pseudoplatelets was observed more often in the optical method than in the impedance method.


H Quantitative flow cytometry (QFC) had the highest CV of all platelet counting methods.


I A monoclonal phycoerythrin-labelled anti-integrin alpha chain 2b antibody was used for the platelet counts by QFC.


J Current clinical guidelines suggest a prophylactic platelet transfusion threshold of 100 x 109 additional bleeding risk factors.


/L for patients without


K The authors conclude that, where pseudoplatelets are detected in the blood smear, platelets should be counted using QFC, or manually if QFC is not available.


TRUE FALSE TRUE FALSE TRUE FALSE


L All four patients with relapsed acute leukaemia presented pseudoplatelets in peripheral blood.


M There were equal numbers of male and female patients with AML-5.


N Falsely low platelet counts are induced by platelet-white blood cell aggregates.


TRUE FALSE


O The results of the study suggest that patients with ALL are more likely to present with blast cell fragments than are those with AML.


P Morphologic features of the pseudoplatelets were comparable to agranular platelets but with deeply stained cytoplasm.


TRUE FALSE


Q Three of the patients presenting with blast cell fragments on stained blood smears had identical platelet counts with one of the impedance-based methods.


TRUE FALSE


R Van der Meer et al. (2003) reported spurious automated platelet counts due to blast cell fragments.


TRUE FALSE TRUE FALSE


S All of the patients in the study presented with acute leukaemia at onset and had ≥0.5 x 109


blasts.


T One patient out of the 11 in whom blast cell fragments were observed in blood smears had ALL-T.


REFLECTIVE LEARNING QUESTIONS – See page 268 272 MAY 2016 THE BIOMEDICAL SCIENTIST TRUE FALSE /L circulating TRUE FALSE


TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE


TRUE FALSE TRUE FALSE


TRUE FALSE


TRUE FALSE TRUE FALSE TRUE FALSE TRUE FALSE


TRUE FALSE


TRUE FALSE


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