1

Hematology

1. Anticoagulant of choice for platelet studies

a. Citrate
b. EDTA
c. Heparin
d. Oxalate

2. Most preferable site for bone marrow aspiration and biopsy in an adult
a. Iliac crest
b. Sternum
c. Tibia
d. Spinous processes of a vertebra

3. Non-infectious wet wastes should be disposed in a ___ colored container

a. Red
b. Black
c. Green
d. Yellow with a black band

4. Most predominant cell in an adult bone marrow:

a. Prolymphocyte
b. Metamyelocyte
c. Promonocyte
d. Metarubricyte

5. Defibrinated blood can be used on all of the following tests EXCEPT:

a. EOFT
b. Autohemolysis test
c. Ham’s acidified serum test
d. Donath-Landsteiner test

6. Which of the following forms of hemoglobin cannot be measured by the

hemiglobincyanide method?
a. Carboxyhemoglobin
b. Carbaminohemoglobin
c. Sulfhemoglobin
d. Methemoglobin

7. What is the effect of pancytosis on ESR result?

a. Increased
b. Decreased
c. Variable
d. Not affected

8. Using a Coulter counter analyzer, an increased RDW should correlate

with:
a. Spherocytosis
b. Anisocytosis
c. Poikilocytosis
d. Leukoerythroblastosis
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9. A miller disc is an ocular device used to facilitate counting of:

1. Polychromatophilic erythrocytes 3. Nucleated RBCs
2. Reticulocytes 4. Platelets
a. 1 and 2
b. 2 only
c. 1, 2 and 3
d. 4 only

10. A defective centrifuge was used to determine a hematocrit value. Which

of the following parameters will not be affected?
a. MCH
b. MCHC
c. MCV
d. RDW

11. What effect would using a buffer at pH 6.0 have on a Wright-stained

smear?
a. Red cells would be stained too blue
b. Red cells would be stained too pink
c. White cell cytoplasm would be stained too blue
d. Red cells could lyse on the slide

12. The naphthol AS-D chloroacetate esterase stain is positive on which

type of cell?
a. Megakaryoblast
b. Prolymphocyte
c. Promonocyte
d. Myeloblast

13. What is the principle of automated impedance cell counters?

a. Angle of laser beam scatter by cells
b. Amplification of an electrical current by cells
c. Interruption of an electrical current by cells
d. Change in optical density of the solution containing cells

14. Side angle scatter in a laser-based cell counting system is used to

measure:
a. Cell size
b. Cytoplasmic granularity
c. Cell number
d. Antigenic identification

15. A WBC count is done on an automated impedance cell counter from a

patient with leukoerythroblastosis. The WBC count is most likely:
a. Falsely increased due to nRBCs
b. Falsely increased due to RBC fragments
c. Falsely decreased due to nRBCs
d. Accurate; no error with this methodology
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16. Automated cell counters should be calibrated:

a. At least every 6 months
b. After replacement of any major part
c. Using commercially available controls
d. All of the above

17. On automated hematology analyzers, marked red blood cell fragments

will cause an abnormal histogram and/or scatterplots for:
a. WBCs and RBCs
b. RBCs and platelets
c. WBCs and platelets
d. WBCs, RBCs and platelets

18. G-6-PD deficiency is an abnormality in:

a. Rapoport-Luebering pathway
b. Embden-Meyerhoff pathway
c. Methemoglobin reductase pathway
d. Hexose monophosphate shunt

19. Nonspecific granules appear at what stage of the myelocytic series?

a. Myeloblast
b. Myelocyte
c. Promyelocyte
d. Juvenile granulocyte

20. The demarcating membrane system (DMS) begins to form in what stage of
platelet maturation?
a. Megakaryoblast
b. Promegakaryocyte
c. Megakaryocyte
d. Metamegakaryocyte

21. Stem cell marker:

a. CD16
b. CD56
c. CD34
d. CD10

22. A well-defined hof and a cart-wheel like pattern of chromatin are

characteristics of:
a. Macrophages
b. Plasma cells
c. Megakaryocytes
d. Mast cells

23. A single megakaryocyte can produce how many platelets?

a. 1,000-3,000
b. 5,000-7,000
c. 4,000-6,000
d. 2,000-4,000
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24. Drabkin’s solution contains:

a. Calcium chloride
b. Cyanide
c. Magnesium sulfate
d. Sulfosalicylic acid

25. The color of Wright-stained RBCs may be adjusted by:

a. Dipping the slide in methanol before staining
b. Rapid drying of slides
c. Adjusting the buffer pH
d. Decreasing the concentration of glycerol in the stain

26. The addition of 0.5 mL of blood to 4.5 mL of diluent results in a

dilution of:
a. 1:5
b. 1:50
c. 1:20
d. 1:10

27. Which determination is considered a reliable assessment of effective

erythropoiesis in the bone marrow?
a. Reticulocyte count
b. Hemoglobin
c. RBC count
d. M:E ratio

28. The specific diagnosis of sickle cell anemia can be made from which of
the following laboratory tests?
a. Solubility test
b. Sodium metabisulfite
c. Hemoglobin electrophoresis
d. Presence of sickle cells

29. Which among the following instruments applies the principle of optical
light scattering?
a. Fibrometer
b. Technicon autoanalyzer
c. Coulter counter
d. Sysmex counter

30. A clotted EDTA tube can be used to perform a(n):

a. Platelet count
b. ESR
c. Hematocrit
d. Solubility test for HbS

31. In the platelet count procedure using phase microscopy:

a. Platelets appear dark against a light background
b. The entire ruled counting surface of the hemocytometer is used
c. Ammonium oxalate will lyse the WBCs
d. Platelets should be counted immediately after plating the
hemacytometer
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32. The blood smear made on a patient with polycythemia vera is too short.
What should be done to correct this problem?
a. Decrease the angle of the spreader slide
b. Increase the angle of the spreader slide
c. Adjust the angle of the spreader slide to 45 degrees
d. Use a smaller drop of blood

33. If a patient with an RBC count of 2.90 x 1012/L has a reticulocyte

count of 9.0%, what is the absolute reticulocyte count in SI units?
a. 2.61 x 109/L
b. 26.1 x 109/L
c. 261 x 109/L
d. 261 x 103/μL

34. Which of the following would not be the cause of a falsely high MCHC
of 40.5 g/dL on an automated instrument?
a. Hereditary spherocytosis
b. Lipemia
c. Presence of cold agglutinins
d. Instrument sampling or mixing error

35. A Wintrobe tube is graduated between

a. 0-18 mm
b. 0-50 mm
c. 0-100 mm
d. 0-200 mm

36. A platelet count of 100,000-150,000/μL is reported as:

a. Normal
b. Low normal
c. Slightly decreased
d. Moderately decreased

37. A stomatocyte grading of 3+ indicates how many stomatocytes per oil-

immersion field?
a. 0-2/oio
b. 2-10/oio
c. 10-20/oio
d. 20-50/oio

38. Which of the following types of hemoglobin is the fastest to migrate

on cellulose acetate hemoglobin electrophoresis?
a. A1
b. Bart
c. I
d. H
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39. Fetal hemoglobin can be detected by:

a. Sickle preparation
b. Osmotic fragility test
c. Measuring alkali-resistant hemoglobin
d. Looking for basophilic stippling

40. Which of the following blood stains is used to demonstrate

reticulocyte?
a. Wright’s stain
b. Brilliant cresyl blue
c. May-Grunwald
d. Giemsa

41. A blood pressure cuff is needed to carry out the following test(s):
1. Ivy’s bleeding test 3. Coomb’s test
2. Duke’s bleeding test 4. Lee and White clotting time
a. 1 only
b. 1 and 2
c. 1, 2 and 4
d. 1, 2, 3 and 4

42. Which ratio of anticoagulant to blood is correct for coagulation

procedures?
a. 4:1
b. 1:5
c. 9:1
d. 1:9

43. Which anemia has red cell morphology similar to that seen in iron
deficiency anemia?
a. Sickle cell anemia
b. Thalassemia
c. Pernicious anemia
d. Hereditary spherocytosis

44. Which type of anemia is usually present in a patient with acute

leukemia?
a. Microcytic, hyperchromic
b. Microcytic, hypochromic
c. Normocytic, normochromic
d. Macrocytic, normochromic

45. Iron deficiency anemia may be distinguished from anemia of chronic

infection by:
a. Serum iron level
b. Red cell morphology
c. Red cell indices
d. TIBC
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46. In which of the following conditions does LAP show the least activity?
1. Leukemoid reaction 3. Chronic Myelogenous Leukemia
2. Idiopathic myelofibrosis 4. Polycythemia vera
a. 1, 2 and 4
b. 2, 3 and 4
c. 3 only
d. 1 only

47. Cells exhibiting a positive stain with tartrate-resistant acid

phosphatase are characteristically seen in:
a. Infectious mononucleosis
b. Hairy cell leukemia
c. Sezary syndrome
d. Gaucher’s disease

48. Auer rods may be seen in which of the following:

1. Acute myeloblastic leukemia 3. Acute promyelocytic leukemia
2. Acute lymphoblastic leukemia 4. Acute myelomonocytic leukemia
a. 1, 2 and 3
b. 2, 3 and 4
c. 1, 3 and 4
d. 1, 2, 3 and 4

49. In myelofibrosis, the characteristic poikilocyte is:

a. Codocyte
b. Schistocyte
c. Drepanocyte
d. Dacryocyte

50. According to FAB, to establish the diagnosis for leukemia, the

percentage of blasts found in the bone marrow should be:
a. ≥20%
b. ≥30%
c. ≥15%
d. ≥40%

51. Stage in the myelocytic series wherein a given granulocyte can be

identified:
a. Promyelocyte
b. Myeloblast
c. Metamyelocyte
d. Myelocyte

52. A term that describes a plasma cell with red to pink cytoplasm is
known as:
a. Grape cell
b. Morula cell
c. Flame cell
d. Plasmacytoid lymphocyte
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53. Faggot cells are predominantly seen in which type of leukemia?

a. M1
b. M2
c. M3
d. M4

54. Which of these tests will determine the inability of phagocyte to kill
ingested microorganisms?
a. LAP score
b. NBT dye test
c. Boyden chamber assay
d. All of these

55. Oval macrocytes, Howell-Jolly bodies and hypersegmented neutrophils

are associated with what condition?
a. Broadfish tapeworm infection
b. Cyanocobalamin deficiency
c. Pteroylglutamic acid deficiency
d. All of these

56. Which of the following stains are most often positive in ALL but are
negative in AML?
1. Terminal deoxyribonucleotidase 3. Esterases
2. Periodic acid Schiff 4. Sudan black B
a. 1 and 3
b. 1, 2 and 4
c. 1 and 2
d. 1, 2, 3 and 4

57. Which organ removes erythrocyte inclusions without destroying the

cell?
a. Liver
b. Spleen
c. Kidney
d. Lymph nodes

58. Hemoglobin configuration characteristic of Hemoglobin H:

a. Gamma4
b. Alpha2-Gamma2
c. Beta4
d. Alpha2-Delta2

59. Which of the following match(es) is(are) incorrect?

1. Stomatocyte – Mouth cell 4. Elliptocyte – Pear-shaped cell
2. Spherocyte – Bronze cell 5. Acanthocyte – Burr cell
3. Schistocyte – Fragmented cell 6. Ovalocyte – Mexican hat cell
a. 1, 2 and 3
b. 4, 5 and 6
c. 2, 4 and 5
d. 3, 5 and 6
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60. Which of the following pathways generates 2,3-Biphosphoglycerate that

regulates hemoglobin affinity for oxygen?
a. Rapoport-Luebering
b. Glycolytic
c. Pentose phosphate
d. Methemoglobin reductase

61. Mauve lavender color of blood is associated with increased

concentration of what hemoglobin?
a. Carboxyhemoglobin
b. Methemoglobin
c. Oxyhemoglobin
d. Sulfhemoglobin

62. Which of the following is incorrect regarding aplastic anemia?

a. May be due to drugs such as chloramphenicol, or chemicals such as
benzene
b. Congenital type is known as Diamond-Blackfan anemia
c. Pancytopenia
d. RBCs are normocytic and normochromic

63. If the area of RBC palor is three-fourths (3/4) of the cell diameter,
the degree of hypochromia is graded as:
a. 1+
b. 2+
c. 3+
d. 4+

64. Factors that cause shift to the right in the Oxyhemoglobin

Dissociation Curve:
1. Increased pH 3. Increased temperature
2. Decreased 2,3-BPG 4. Increased pCO2
a. 1 and 2
b. 3 and 4
c. 1, 3 and 4
d. 2, 3 and 4

65. In the Pelger-Huet anomaly, neutrophils show:

a. A shift to the left
b. Dohle bodies
c. 2 lobes and hyperclumped chromatin
d. Toxic granulation

66. Ehler-Danlos, von Willebrand and Bernard Soulier are all qualitative
platelet disorders that have abnormalities of:
a. Adhesion
b. Aggregation
c. Granule release
d. None of the above
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67. A bleeding tendency is likely to be present when the platelet count is

below:
a. 50,000/μL
b. 150,000/μL
c. 200,000/μL
d. 400,000/μL

68. The phase contrast microscope is employed in which platelet count

method?
a. Rees-Ecker
b. Brecker-Cronkite
c. Indirect
d. Coulter

69. A disorder characterized by a very high platelet count yet

functionally abnormal platelets:
a. Glanzmann’s thrombasthenia
b. Essential thrombocythemia
c. Acute megakaryocytic leukemia
d. Thrombotic thrombocytopenic purpura

70. Aspirin prevents platelet aggregation by inhibiting the action of

which enzyme?
a. Phospholipase
b. Thromboxane A2 synthetase
c. Prostacyclin synthetase
d. Cyclooxygenase

71. Contents of platelet dense granules:

1. Serotonin 3. ADP 5. ATP
2. Fibrinogen 4. Platelet factor 6. Calcium
a. 1, 2, 3 and 5
b. 1, 4, 5 and 6
c. 1, 3, 5 and 6
d. 1, 3, 4 and 6

72. Which part of the platelet structure serves as the site of arachidonic
acid metabolism?
a. Microfilaments
b. Dense tubular system
c. Microtubules
d. Glycocalyx

73. This factor is essential for normal platelet aggregation:

a. Calcium
b. Glycoprotein Ib
c. von Willebrand factor
d. Glycoprotein IIb-IIIa complex
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74. On a well stained blood smear of a normal patient, there should be how
many platelets in each oil immersion field?
a. 8-20
b. 6-8
c. 4-5
d. 5-10

75. Part of the platelet structure major responsible for clot retraction:
a. β-Thromboglobulin
b. Thrombospondin
c. Thrombosthenin
d. Canalicular system

76. Which of the following does not contribute to hemostasis?

a. Liver
b. Endothelial cells
c. Thrombocytes
d. None of these

77. The activity of the lupus anticoagulant and anticardiolipin antibodies

appears to be directed against:
a. Factor V
b. Factor VIII
c. Factor IX
d. Phospholipid

78. 5M urea or 1% monochloroacetic acid are reagents used in tests for

which plasma factor deficiency?
a. VIII
b. IX
c. XII
d. XIII

79. Laboratory results from a patient with DIC are:

1. Decreased platelets 3. Positive D-dimer
2. Increased factors I, V and VIII 4. Prolonged APTT
a. 1, 2 and 3
b. 1, 3 and 4
c. 2, 3 and 4
d. 1, 2, 3 and 4

80. Prolonged PT and APTT are corrected with aged serum, but not with
adsorbed plasma. What factor is deficient?
a. I
b. II
c. V
d. X
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81. Which of the following coagulation test results is normal in a patient

with classic von Willebrand’s disease?
a. Bleeding time
b. APTT
c. Platelet count
d. Factor VIII:C and vWF levels

82. How is the endpoint in platelet aggregation test using aggregometer

detected?
a. Change in optical density
b. Turbidity
c. Clot formation via clotting time
d. Clot formation via specific gravity

83. Which among these factors is present in adsorbed plasma but not in
aged serum?
a. XI
b. II
c. VII
d. VIII

84. Epsilon aminocaproic acid is an inhibitor of:

a. Platelet activation
b. Fibrinolysis
c. Fibrin clot stabilization
d. Collagent attachment

85. A positive protamine sulfate test is suggestive of:

a. DIC
b. vWD
c. Glanzmann’s thrombasthenia
d. Primary fibrinolysis

86. Incorrect statement regarding oral anticoagulants:

a. PT is used to monitor the dosage
b. Not recommended for pregnant and lactating women
c. Vitamin K antagonist
d. Needs antithrombin III as a cofactor

87. Liver disease is characterized by all of the following EXCEPT:

a. Prolonged PT
b. Acanthocytosis
c. Decreased factor VIII
d. Decreased fibrinogen

88. Hemorrhagic disease of newborns is often due to hypoprothrombinemia.

This condition may be prevented by giving expectant mothers adequate doses
of:
a. Vitamin A
b. Vitamin C
c. Vitamin D
d. Vitamin K
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89. Activators used in the activated partial thromboplastin time:

1. Ellagic acid 3. Micronized silica
2. Celite 4. Kaolin
a. 1 and 2
b. 1, 2 and 3
c. 2, 3 and 4
d. 1, 2, 3 and 4

90. Variables to consider in the visual detection of fibrin clot formation

(tilt tube method):
a. Temperature
b. Pipetor calibration
c. Accuracy of timing devices
d. All of the above

91. What solution is used to decontaminate the probes in an

electromechanical instrument such as the fibrometer?
a. 0.85% NaCl
b. 2% Acetic acid
c. Tap water
d. 0.1N HCl

92. Which of the following aggregating agents is very difficult to store

because of its susceptibility to oxidation?
a. ADP
b. Epinephrine
c. Arachidonic acid
d. Collagen

93. In the Coulter Counter electrical impedance instrument, the R1 flag in

flagging indicates:
a. Increased granulocyte count
b. Overlap of cell populations at the lymphocyte-mononuclear boundary
c. Presence of nucleated RBCs, giant platelets or sickle cells
d. Overlap of cells at the mononuclear-granulocyte boundary

94. In the Sysmex cell counting instruments, an ‘asterisk with a number’

flag indicates:
a. A value exceeds the linearity of the system
b. Values are outside the numerical limits preset by the user
c. Analysis error
d. Distribution error

95. The size threshold range used by electrical impedance methods to count
particles as platelets is:
a. 0-10 fL
b. 2-20 fL
c. 15-40 fL
d. 35-90 fL
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96. If a physician suspects a qualitative platelet defect, the most useful

test to order is:
a. Platelet count
b. Prothrombin time
c. Duckert’s test
d. Bleeding time

97. The expected screening test results for a patient with a fibrin
stabilizing factor deficiency are:
a. Prolonged PT
b. Prolonged APTT
c. Prolonged PT and APTT
d. Normal PT and APTT

98. 0.01 mL of blood is diluted in 1.99 mL of diluent. This dilution is

plated on both sides of a Neubauer counting chamber. A total of 453 cells
is seen when both large center squares are counted. The platelet count
expressed in SI units is:
a. 453 x 109/L
b. 453 x 103/μL
c. 227 x 109/L
d. 906 x 109/L

99. The platelet parameter PDW refers to the:

a. Average platelet volume
b. Cell weight versus density
c. Variation in platelet cell size
d. Capacity to adhere to foreign substances

100. Causes of positive errors in particle-counting instruments, EXCEPT:

a. Aperture plugs
b. Bubbles in the sample
c. Extraneous electrical pulses
d. Excessive lysing of RBCs
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ANSWER KEY: Hematology

1. A 21. C 41. A 61. D 81. C

2. A 22. B 42. D 62. B 82. A
3. C 23. D 43. B 63. C 83. D
4. B 24. B 44. C 64. B 84. B
5. D 25. C 45. D 65. C 85. A
6. C 26. D 46. C 66. A 86. D
7. B 27. A 47. B 67. A 87. C
8. B 28. C 48. C 68. B 88. D
9. A 29. B 49. D 69. B 89. D
10. A 30. D 50. B 70. D 90. D
11. B 31. A 51. D 71. C 91. B
12. D 32. A 52. C 72. B 92. C
13. C 33. C 53. C 73. D 93. C
14. B 34. A 54. B 74. A 94. A
15. A 35. C 55. D 75. C 95. B
16. D 36. C 56. C 76. D 96. D
17. B 37. D 57. B 77. D 97. D
18. D 38. D 58. C 78. D 98. A
19. C 39. C 59. B 79. B 99. C
20. B 40. B 60. A 80. D 100. D