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Exam Prep

Haematology practice questions.

Red and white cell disorders, leukaemia, haemostasis, transfusion and laboratory quality.

All subjects

Independent practice questions written by Labologics. Not affiliated with DHA, DOH (formerly HAAD), SCFHS, Prometric or any exam body. Not recalled exam questions.

RBC basics

Q1 RBC basics · Easy

A patient has an RBC count of 5.0 x10^12/L and a hematocrit of 45%. What is the MCV?

  1. A: 9 fL
  2. B: 111 fL
  3. C: 90 fL
  4. D: 22.5 fL
Show answer

Answer: C — 90 fL

MCV (fL) = Hct (%) x 10 / RBC (x10^12/L) = 450 / 5.0 = 90 fL.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q2 RBC basics · Easy

Hb is 15 g/dL and the RBC count is 5.0 x10^12/L. What is the MCH?

  1. A: 3 pg
  2. B: 33 pg
  3. C: 75 pg
  4. D: 30 pg
Show answer

Answer: D — 30 pg

MCH (pg) = Hb (g/dL) x 10 / RBC (x10^12/L) = 150 / 5.0 = 30 pg.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q3 RBC basics · Easy

Hb is 15 g/dL and the hematocrit is 45%. What is the MCHC?

  1. A: 30.0 g/dL
  2. B: 3.0 g/dL
  3. C: 33.3 g/dL
  4. D: 300 g/dL
Show answer

Answer: C — 33.3 g/dL

MCHC (g/dL) = Hb (g/dL) x 100 / Hct (%) = 1500 / 45 = 33.3 g/dL.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q4 RBC basics · Medium

An automated CBC reports an MCHC of 39 g/dL. The smear shows no spherocytes. What is the most appropriate first action?

  1. A: Report the result as hereditary spherocytosis
  2. B: Investigate interference such as cold agglutinins or lipemia (e.g., warm to 37 C and re-run)
  3. C: Dilute the sample with water and multiply the result
  4. D: Release the result without comment
Show answer

Answer: B — Investigate interference such as cold agglutinins or lipemia (e.g., warm to 37 C and re-run)

An MCHC above about 36-37 g/dL is physiologically implausible except with spherocytes. Without spherocytes, suspect analytical interference (cold agglutinins, lipemia, icterus) and investigate before reporting.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q5 RBC basics · Easy

The RDW is a measure of:

  1. A: Variation in RBC shape (poikilocytosis)
  2. B: Hemoglobin content per cell
  3. C: Reticulocyte maturation
  4. D: Variation in RBC size (anisocytosis)
Show answer

Answer: D — Variation in RBC size (anisocytosis)

RDW is the coefficient of variation (or SD) of the RBC volume distribution, so it reflects anisocytosis.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q6 RBC basics · Easy

Which stain is used for a manual reticulocyte count?

  1. A: Wright stain
  2. B: Prussian blue
  3. C: New methylene blue
  4. D: Sudan black B
Show answer

Answer: C — New methylene blue

Reticulocytes are counted after supravital staining (new methylene blue or brilliant cresyl blue), which precipitates residual ribosomal RNA.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q7 RBC basics · Medium

Reticulocyte count is 6% and hematocrit is 20% (reference Hct 45%). What is the corrected reticulocyte count?

  1. A: 13.5%
  2. B: 2.7%
  3. C: 6.0%
  4. D: 1.2%
Show answer

Answer: B — 2.7%

Corrected retic = observed retic x (patient Hct / normal Hct) = 6 x 20/45 = 2.7%.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q8 RBC basics · Easy

What is the normal lifespan of a red blood cell in circulation?

  1. A: About 30 days
  2. B: About 120 days
  3. C: About 10 days
  4. D: About 7 days
Show answer

Answer: B — About 120 days

Normal RBC survival is about 120 days. Platelets survive about 7-10 days.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q9 RBC basics · Easy

Erythropoietin in adults is produced mainly by:

  1. A: Peritubular interstitial cells of the kidney
  2. B: Hepatocytes
  3. C: Bone marrow stromal cells
  4. D: Adrenal cortex
Show answer

Answer: A — Peritubular interstitial cells of the kidney

About 90% of adult EPO comes from peritubular interstitial cells of the renal cortex in response to hypoxia; the liver is the main fetal source.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q10 RBC basics · Easy

Normal adult hemoglobin A has which globin chain composition?

  1. A: Two alpha and two gamma chains
  2. B: Two alpha and two delta chains
  3. C: Four beta chains
  4. D: Two alpha and two beta chains
Show answer

Answer: D — Two alpha and two beta chains

HbA is alpha2beta2. HbF is alpha2gamma2, HbA2 is alpha2delta2, and HbH is beta4.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Microcytic anemia

Q11 Microcytic anemia · Easy

In an otherwise healthy patient, which single test is most useful for diagnosing iron deficiency?

  1. A: Serum iron
  2. B: Serum ferritin
  3. C: Total iron-binding capacity
  4. D: Hemoglobin electrophoresis
Show answer

Answer: B — Serum ferritin

A low ferritin is highly specific for depleted iron stores. Ferritin is an acute-phase reactant, so it can be falsely normal in inflammation.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q12 Microcytic anemia · Easy

Which iron profile is typical of iron deficiency anemia?

  1. A: High ferritin, low TIBC, low serum iron
  2. B: High ferritin, high transferrin saturation, high serum iron
  3. C: Low ferritin, high TIBC, low transferrin saturation
  4. D: Low ferritin, low TIBC, high transferrin saturation
Show answer

Answer: C — Low ferritin, high TIBC, low transferrin saturation

Iron deficiency depletes stores (low ferritin) and raises transferrin production (high TIBC), so saturation falls.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q13 Microcytic anemia · Medium

Which iron profile is most typical of anemia of chronic disease (inflammation)?

  1. A: Low serum iron, high TIBC, low ferritin
  2. B: High serum iron, high transferrin saturation, high ferritin
  3. C: Low serum iron, low TIBC, normal or raised ferritin
  4. D: Normal serum iron, high TIBC, low ferritin
Show answer

Answer: C — Low serum iron, low TIBC, normal or raised ferritin

Inflammation raises hepcidin, trapping iron in macrophages: serum iron falls, TIBC falls, ferritin is normal or high.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q14 Microcytic anemia · Medium

Which molecule is the key mediator of iron sequestration in anemia of chronic disease?

  1. A: Erythropoietin
  2. B: Haptoglobin
  3. C: Transferrin receptor
  4. D: Hepcidin
Show answer

Answer: D — Hepcidin

IL-6 induces hepatic hepcidin, which degrades ferroportin and blocks iron export from enterocytes and macrophages.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q15 Microcytic anemia · Medium

A patient has Hb 11.5 g/dL, RBC 6.2 x10^12/L, MCV 64 fL and a normal RDW. Which diagnosis is most likely?

  1. A: Iron deficiency anemia
  2. B: Beta-thalassemia trait
  3. C: Anemia of chronic disease
  4. D: Sideroblastic anemia
Show answer

Answer: B — Beta-thalassemia trait

A high RBC count with marked microcytosis and normal RDW favors thalassemia trait. Mentzer index (MCV/RBC) = 10.3; below 13 favors thalassemia. Confirm with HbA2 quantitation.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q16 Microcytic anemia · Medium

Which finding confirms beta-thalassemia trait?

  1. A: Positive sickle solubility test
  2. B: Increased osmotic fragility
  3. C: Raised HbA2 on HPLC or electrophoresis
  4. D: Positive Kleihauer-Betke test
Show answer

Answer: C — Raised HbA2 on HPLC or electrophoresis

HbA2 above about 3.5% is the diagnostic marker of beta-thalassemia trait.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q17 Microcytic anemia · Hard

How does coexisting iron deficiency affect HbA2 in a person with beta-thalassemia trait?

  1. A: It raises HbA2 above 8%
  2. B: It lowers HbA2 and can mask the diagnosis
  3. C: It has no effect on HbA2
  4. D: It converts HbA2 to HbF
Show answer

Answer: B — It lowers HbA2 and can mask the diagnosis

Iron deficiency reduces HbA2, so a borderline result may normalise. Correct iron deficiency and repeat HbA2 if thalassemia is suspected.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q18 Microcytic anemia · Medium

Ring sideroblasts are demonstrated with which stain?

  1. A: New methylene blue on peripheral blood
  2. B: Periodic acid-Schiff
  3. C: Myeloperoxidase
  4. D: Prussian blue (Perls) on bone marrow
Show answer

Answer: D — Prussian blue (Perls) on bone marrow

Ring sideroblasts are erythroblasts with iron-laden mitochondria around the nucleus, seen with Perls Prussian blue on a marrow aspirate.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q19 Microcytic anemia · Easy

A child with microcytic anemia and coarse basophilic stippling has a history of chewing old paint. What is the most likely cause?

  1. A: Iron deficiency anemia
  2. B: Hereditary spherocytosis
  3. C: G6PD deficiency
  4. D: Lead poisoning
Show answer

Answer: D — Lead poisoning

Lead inhibits pyrimidine 5'-nucleotidase (causing retained RNA seen as coarse stippling) and heme synthesis enzymes.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q20 Microcytic anemia · Hard

Lead interferes with heme synthesis mainly by inhibiting:

  1. A: Transferrin and ferritin
  2. B: ALA dehydratase and ferrochelatase
  3. C: G6PD and pyruvate kinase
  4. D: Erythropoietin receptor signalling
Show answer

Answer: B — ALA dehydratase and ferrochelatase

Lead inhibits delta-ALA dehydratase and ferrochelatase, so ALA and zinc protoporphyrin accumulate.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Macrocytic anemia

Q21 Macrocytic anemia · Easy

A neutrophil is considered hypersegmented when it has:

  1. A: Three lobes
  2. B: Four lobes
  3. C: Six or more lobes (or more than 5% of neutrophils with five lobes)
  4. D: A band-shaped nucleus
Show answer

Answer: C — Six or more lobes (or more than 5% of neutrophils with five lobes)

Hypersegmentation is an early, sensitive sign of megaloblastic anemia.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q22 Macrocytic anemia · Medium

Serum methylmalonic acid and homocysteine are both raised. Which deficiency is most likely?

  1. A: Vitamin B12
  2. B: Folate
  3. C: Iron
  4. D: Vitamin K
Show answer

Answer: A — Vitamin B12

B12 is a cofactor for both methylmalonyl-CoA mutase and methionine synthase, so both metabolites rise. Folate deficiency raises homocysteine only.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q23 Macrocytic anemia · Medium

Homocysteine is raised but methylmalonic acid is normal. Which deficiency is most likely?

  1. A: Vitamin B12
  2. B: Iron
  3. C: Folate
  4. D: Copper
Show answer

Answer: C — Folate

Folate is needed for methionine synthase only; methylmalonic acid metabolism needs B12 alone.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q24 Macrocytic anemia · Easy

Which antibodies are characteristic of pernicious anemia?

  1. A: Anti-dsDNA antibodies
  2. B: Anti-tissue transglutaminase antibodies
  3. C: Anti-intrinsic factor and anti-parietal cell antibodies
  4. D: Warm IgG anti-RBC antibodies
Show answer

Answer: C — Anti-intrinsic factor and anti-parietal cell antibodies

Autoimmune gastritis destroys parietal cells; anti-intrinsic factor antibodies are more specific, anti-parietal cell antibodies more sensitive.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q25 Macrocytic anemia · Medium

A patient with a raised GGT has round macrocytes, target cells and normally segmented neutrophils. What is the most likely cause?

  1. A: Pernicious anemia
  2. B: Folate deficiency
  3. C: Alcohol-related liver disease
  4. D: Hereditary spherocytosis
Show answer

Answer: C — Alcohol-related liver disease

Round (not oval) macrocytes with target cells and no hypersegmentation suggest non-megaloblastic macrocytosis, as in liver disease or alcohol.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q26 Macrocytic anemia · Easy

Subacute combined degeneration of the spinal cord is associated with deficiency of:

  1. A: Folate
  2. B: Vitamin B12
  3. C: Iron
  4. D: Vitamin C
Show answer

Answer: B — Vitamin B12

Neurological damage is a feature of B12 deficiency. Treating it with folate alone can correct the anemia while neurological damage progresses.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q27 Macrocytic anemia · Easy

A strict vegan for ten years develops macrocytic anemia. Which deficiency is most likely?

  1. A: Folate
  2. B: Iron
  3. C: Vitamin B12
  4. D: Vitamin B6
Show answer

Answer: C — Vitamin B12

B12 comes almost exclusively from animal foods; folate is plentiful in vegetables.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q28 Macrocytic anemia · Hard

Pancytopenia with oval macrocytes, hypersegmented neutrophils, very high LDH and raised indirect bilirubin is best explained by:

  1. A: Ineffective erythropoiesis in megaloblastic anemia
  2. B: Aplastic anemia
  3. C: Hereditary spherocytosis
  4. D: Acute blood loss
Show answer

Answer: A — Ineffective erythropoiesis in megaloblastic anemia

Megaloblastic precursors die in the marrow (intramedullary hemolysis), raising LDH and bilirubin. Aplastic anemia does not show these features.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Hemolytic anemia

Q29 Hemolytic anemia · Medium

Which finding best indicates intravascular rather than extravascular hemolysis?

  1. A: Hemoglobinuria with markedly reduced haptoglobin
  2. B: Splenomegaly
  3. C: Spherocytes on the smear
  4. D: Raised reticulocyte count
Show answer

Answer: A — Hemoglobinuria with markedly reduced haptoglobin

Free plasma Hb binds and depletes haptoglobin and spills into urine. Haptoglobin can fall in both, but hemoglobinuria and hemosiderinuria point to intravascular lysis.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q30 Hemolytic anemia · Medium

A child has spherocytes, splenomegaly, a negative DAT and a family history of anemia. What is the most likely diagnosis?

  1. A: Warm autoimmune hemolytic anemia
  2. B: G6PD deficiency
  3. C: Hereditary spherocytosis
  4. D: Beta-thalassemia major
Show answer

Answer: C — Hereditary spherocytosis

Spherocytes with a negative DAT and family history suggest HS. Supporting tests are increased osmotic fragility and reduced EMA binding on flow cytometry.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q31 Hemolytic anemia · Easy

Spherocytes with a positive DAT (anti-IgG) suggest:

  1. A: Hereditary spherocytosis
  2. B: Iron deficiency anemia
  3. C: Warm autoimmune hemolytic anemia
  4. D: Lead poisoning
Show answer

Answer: C — Warm autoimmune hemolytic anemia

IgG-coated RBCs are partly phagocytosed by splenic macrophages, leaving spherocytes. A positive DAT separates immune from hereditary causes.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q32 Hemolytic anemia · Easy

A man with G6PD deficiency becomes jaundiced after eating fava beans. A supravital stain shows RBC inclusions. These inclusions are:

  1. A: Howell-Jolly bodies
  2. B: Heinz bodies (denatured hemoglobin)
  3. C: Pappenheimer bodies
  4. D: Cabot rings
Show answer

Answer: B — Heinz bodies (denatured hemoglobin)

Oxidant stress denatures Hb into Heinz bodies, visible with crystal violet or brilliant cresyl blue; splenic removal of them creates bite cells.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q33 Hemolytic anemia · Hard

Why can a G6PD activity assay be falsely normal during an acute hemolytic episode?

  1. A: Bilirubin inhibits the assay
  2. B: G6PD is synthesised faster during hemolysis by mature RBCs
  3. C: Hemolysed samples always read high
  4. D: Young RBCs and reticulocytes have higher G6PD activity
Show answer

Answer: D — Young RBCs and reticulocytes have higher G6PD activity

The oldest, most deficient cells are destroyed first, leaving young cells with higher enzyme activity. Repeat testing about 2-3 months after the episode.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q34 Hemolytic anemia · Medium

What is the recommended test to diagnose paroxysmal nocturnal hemoglobinuria?

  1. A: Flow cytometry for GPI-anchored proteins (CD55/CD59, FLAER)
  2. B: Ham acid hemolysis test as first line
  3. C: Osmotic fragility test
  4. D: Direct antiglobulin test
Show answer

Answer: A — Flow cytometry for GPI-anchored proteins (CD55/CD59, FLAER)

PNH results from acquired PIGA mutation and loss of GPI-anchored complement regulators. High-sensitivity flow cytometry has replaced the Ham test.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q35 Hemolytic anemia · Hard

Paroxysmal cold hemoglobinuria is caused by which antibody?

  1. A: Warm IgG anti-Rh antibody
  2. B: IgM anti-I cold agglutinin at 37 C
  3. C: Biphasic IgG anti-P (Donath-Landsteiner) antibody
  4. D: IgA anti-platelet antibody
Show answer

Answer: C — Biphasic IgG anti-P (Donath-Landsteiner) antibody

The Donath-Landsteiner antibody binds RBCs in the cold and fixes complement causing lysis on warming. It often follows viral infection in children.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q36 Hemolytic anemia · Medium

A patient has schistocytes, severe thrombocytopenia, normal PT/APTT and confusion. Which test confirms the likely diagnosis?

  1. A: Factor VIII assay
  2. B: ADAMTS13 activity
  3. C: D-dimer
  4. D: Osmotic fragility
Show answer

Answer: B — ADAMTS13 activity

This is a thrombotic microangiopathy suggesting TTP. ADAMTS13 activity below 10% confirms TTP. Normal clotting times help separate it from DIC.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Hemoglobinopathies

Q37 Hemoglobinopathies · Easy

The sickle mutation in HbS results in:

  1. A: Valine replacing glutamic acid at position 6 of the beta chain
  2. B: Lysine replacing glutamic acid at position 6 of the beta chain
  3. C: Deletion of both beta-globin genes
  4. D: Deletion of three alpha-globin genes
Show answer

Answer: A — Valine replacing glutamic acid at position 6 of the beta chain

A GAG to GTG change in codon 6 of HBB substitutes valine for glutamic acid. Lysine at the same position gives HbC.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q38 Hemoglobinopathies · Medium

Hemoglobin C results from which substitution in the beta chain?

  1. A: Valine for glutamic acid at position 6
  2. B: Glutamine for glutamic acid at position 121
  3. C: Lysine for glutamic acid at position 6
  4. D: Lysine for glutamic acid at position 26
Show answer

Answer: C — Lysine for glutamic acid at position 6

HbC is beta6 Glu to Lys. (Glu121Gln is HbD-Punjab; Glu26Lys is HbE.)

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q39 Hemoglobinopathies · Medium

A sickle solubility test may be falsely negative in a 3-month-old infant with sickle cell disease because:

  1. A: Infants have no beta chains
  2. B: HbF is still the predominant hemoglobin
  3. C: Infant RBCs lack 2,3-BPG
  4. D: The test reagent is inactivated by bilirubin
Show answer

Answer: B — HbF is still the predominant hemoglobin

HbS concentration is too low while HbF predominates. Use HPLC or electrophoresis for newborn screening.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q40 Hemoglobinopathies · Easy

Both parents have sickle cell trait (HbAS). What is the chance that each child has sickle cell disease (HbSS)?

  1. A: 50%
  2. B: 75%
  3. C: 25%
  4. D: 0%
Show answer

Answer: C — 25%

Autosomal recessive inheritance: AS x AS gives 25% AA, 50% AS, 25% SS.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q41 Hemoglobinopathies · Hard

HbS and HbD migrate together on alkaline electrophoresis. Which method separates them?

  1. A: Citrate agar electrophoresis at acid pH (or HPLC)
  2. B: Repeat alkaline electrophoresis for longer
  3. C: Osmotic fragility test
  4. D: Kleihauer-Betke test
Show answer

Answer: A — Citrate agar electrophoresis at acid pH (or HPLC)

At acid pH HbS separates from HbD/HbG. HPLC also resolves them by retention time; HbD is sickle solubility negative.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q42 Hemoglobinopathies · Medium

Deletion of three alpha-globin genes causes HbH disease. HbH inclusions are best demonstrated by:

  1. A: Incubation with brilliant cresyl blue
  2. B: Prussian blue stain
  3. C: Wright stain alone
  4. D: Acid elution
Show answer

Answer: A — Incubation with brilliant cresyl blue

HbH (beta4) is unstable and precipitates as 'golf ball' inclusions after supravital incubation with brilliant cresyl blue.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q43 Hemoglobinopathies · Medium

Deletion of all four alpha-globin genes produces predominantly which hemoglobin?

  1. A: HbH (beta4)
  2. B: Hb Bart's (gamma4)
  3. C: HbA2 (alpha2delta2)
  4. D: HbF (alpha2gamma2)
Show answer

Answer: B — Hb Bart's (gamma4)

Without alpha chains, gamma chains form tetramers (Hb Bart's), which cannot deliver oxygen, causing hydrops fetalis.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Morphology

Q44 Morphology · Easy

Howell-Jolly bodies are most commonly seen after:

  1. A: Iron therapy
  2. B: Vitamin K deficiency
  3. C: Heparin therapy
  4. D: Splenectomy
Show answer

Answer: D — Splenectomy

Howell-Jolly bodies are nuclear (DNA) remnants normally removed by the spleen.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q45 Morphology · Medium

Pappenheimer bodies are composed of:

  1. A: Iron
  2. B: DNA
  3. C: Denatured hemoglobin
  4. D: Ribosomal RNA
Show answer

Answer: A — Iron

Pappenheimer bodies are iron-containing granules (siderotic granules) that stain with Prussian blue.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q46 Morphology · Easy

Teardrop cells (dacrocytes) with a leukoerythroblastic blood picture suggest:

  1. A: Iron deficiency anemia
  2. B: Hereditary spherocytosis
  3. C: Vitamin B12 deficiency
  4. D: Primary myelofibrosis
Show answer

Answer: D — Primary myelofibrosis

Marrow fibrosis distorts RBCs as they leave the marrow, and extramedullary hematopoiesis releases immature cells.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q47 Morphology · Medium

Target cells are a characteristic feature of all of the following EXCEPT:

  1. A: Thalassemia
  2. B: Obstructive liver disease
  3. C: Hereditary spherocytosis
  4. D: Hemoglobin C disease
Show answer

Answer: C — Hereditary spherocytosis

Target cells reflect excess membrane relative to Hb (thalassemia, HbC, liver disease, post-splenectomy). Spherocytes have reduced membrane.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q48 Morphology · Medium

How can rouleaux be distinguished from true agglutination?

  1. A: Rouleaux persist after saline replacement
  2. B: Agglutination disappears at room temperature
  3. C: Rouleaux disperse when plasma is replaced with saline
  4. D: They cannot be distinguished
Show answer

Answer: C — Rouleaux disperse when plasma is replaced with saline

Rouleaux are caused by raised plasma proteins (e.g., myeloma) and disperse in saline; true agglutinates do not.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q49 Morphology · Easy

Döhle bodies in neutrophils represent:

  1. A: Remnants of rough endoplasmic reticulum (RNA)
  2. B: Fused primary granules
  3. C: Iron deposits
  4. D: Phagocytosed bacteria
Show answer

Answer: A — Remnants of rough endoplasmic reticulum (RNA)

Döhle bodies are pale blue cytoplasmic RNA remnants seen in infection, burns and pregnancy.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q50 Morphology · Medium

A healthy blood donor has many bilobed 'pince-nez' neutrophils with mature, clumped chromatin. This is most consistent with:

  1. A: Megaloblastic anemia
  2. B: Chediak-Higashi syndrome
  3. C: Alder-Reilly anomaly
  4. D: Pelger-Huët anomaly
Show answer

Answer: D — Pelger-Huët anomaly

Pelger-Huët anomaly is an inherited LBR mutation with normal function. Acquired (pseudo-Pelger) forms occur in MDS.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q51 Morphology · Easy

Numerous smudge cells on a blood film are characteristic of:

  1. A: Chronic lymphocytic leukemia
  2. B: Acute promyelocytic leukemia
  3. C: Iron deficiency anemia
  4. D: Polycythemia vera
Show answer

Answer: A — Chronic lymphocytic leukemia

Fragile CLL lymphocytes rupture during smear preparation; adding albumin before spreading reduces this.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q52 Morphology · Medium

Auer rods are formed from:

  1. A: Fused primary (azurophilic) granules
  2. B: Nuclear DNA fragments
  3. C: Ribosomal RNA
  4. D: Glycogen deposits
Show answer

Answer: A — Fused primary (azurophilic) granules

Auer rods are MPO-positive fused primary granules and indicate myeloid lineage; they are not seen in lymphoblasts.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q53 Morphology · Easy

Crescent (banana)-shaped gametocytes are characteristic of:

  1. A: Plasmodium vivax
  2. B: Plasmodium malariae
  3. C: Babesia microti
  4. D: Plasmodium falciparum
Show answer

Answer: D — Plasmodium falciparum

P. falciparum gametocytes are crescent-shaped; other species have round gametocytes.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

WBC disorders

Q54 WBC disorders · Medium

WBC 50 x10^9/L with toxic granulation, a high LAP score and no BCR::ABL1 is most consistent with:

  1. A: Chronic myeloid leukemia
  2. B: Acute myeloid leukemia
  3. C: Chronic lymphocytic leukemia
  4. D: Leukemoid reaction
Show answer

Answer: D — Leukemoid reaction

A leukemoid reaction is a reactive neutrophilia; LAP score is high, whereas it is low in CML.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q55 WBC disorders · Easy

Which is a common cause of eosinophilia?

  1. A: Parasitic (helminth) infection
  2. B: Acute bacterial infection
  3. C: Corticosteroid therapy
  4. D: Viral hepatitis
Show answer

Answer: A — Parasitic (helminth) infection

Helminths and allergic disease are common causes. Corticosteroids and acute bacterial infection usually lower eosinophils.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q56 WBC disorders · Easy

A 17-year-old with sore throat and lymphadenopathy has many large reactive lymphocytes. Which test is most appropriate?

  1. A: Heterophile antibody (monospot) test
  2. B: Bone marrow biopsy
  3. C: Hb electrophoresis
  4. D: Osmotic fragility test
Show answer

Answer: A — Heterophile antibody (monospot) test

This suggests infectious mononucleosis (EBV). Reactive lymphocytes are reactive T cells; EBV-specific serology helps if the monospot is negative.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q57 WBC disorders · Easy

In a healthy 1-year-old child, the predominant white cell is usually the:

  1. A: Neutrophil
  2. B: Monocyte
  3. C: Lymphocyte
  4. D: Eosinophil
Show answer

Answer: C — Lymphocyte

Lymphocytes predominate from early infancy until about 4-5 years of age.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q58 WBC disorders · Easy

WBC count is 10 x10^9/L and lymphocytes are 30%. What is the absolute lymphocyte count?

  1. A: 3.0 x10^9/L
  2. B: 0.3 x10^9/L
  3. C: 30 x10^9/L
  4. D: 7.0 x10^9/L
Show answer

Answer: A — 3.0 x10^9/L

Absolute count = total WBC x percentage = 10 x 0.30 = 3.0 x10^9/L.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q59 WBC disorders · Hard

Döhle-like neutrophil inclusions, giant platelets and thrombocytopenia are caused by mutation of:

  1. A: JAK2
  2. B: PIGA
  3. C: GP1BA
  4. D: MYH9
Show answer

Answer: D — MYH9

MYH9-related disorders (including May-Hegglin anomaly) cause macrothrombocytopenia with Döhle-like inclusions.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Leukemia

Q60 Leukemia · Medium

For AML without a defining genetic abnormality, the WHO blast threshold in blood or marrow is:

  1. A: 20%
  2. B: 5%
  3. C: 10%
  4. D: 30%
Show answer

Answer: A — 20%

WHO uses at least 20% blasts. In WHO 2022, most AML with defining genetic abnormalities no longer require 20%; the older FAB system used 30%.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q61 Leukemia · Easy

Acute promyelocytic leukemia is characterised by which genetic abnormality?

  1. A: t(9;22) BCR::ABL1
  2. B: t(8;21) RUNX1::RUNX1T1
  3. C: inv(16) CBFB::MYH11
  4. D: t(15;17) PML::RARA
Show answer

Answer: D — t(15;17) PML::RARA

APL carries PML::RARA, is associated with DIC, and responds to ATRA and arsenic trioxide.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q62 Leukemia · Medium

Which fusion gene results from t(8;21) in AML?

  1. A: PML::RARA
  2. B: CBFB::MYH11
  3. C: KMT2A::MLLT3
  4. D: RUNX1::RUNX1T1
Show answer

Answer: D — RUNX1::RUNX1T1

t(8;21) is a core-binding factor AML with a relatively favourable prognosis.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q63 Leukemia · Hard

AML with inv(16) or t(16;16) typically shows which morphological feature?

  1. A: Faggot cells with many Auer rods
  2. B: Hairy cytoplasmic projections
  3. C: Abnormal eosinophils with large basophilic granules
  4. D: Smudge cells
Show answer

Answer: C — Abnormal eosinophils with large basophilic granules

inv(16) (CBFB::MYH11) shows myelomonocytic blasts with abnormal eosinophils. Faggot cells are typical of APL.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q64 Leukemia · Easy

Blasts that are strongly myeloperoxidase (MPO) positive indicate:

  1. A: B-lymphoid lineage
  2. B: T-lymphoid lineage
  3. C: Myeloid lineage
  4. D: Plasma cell lineage
Show answer

Answer: C — Myeloid lineage

MPO (or Sudan black B) positivity in at least 3% of blasts supports AML. Lymphoblasts are MPO negative.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q65 Leukemia · Medium

Diffuse nonspecific esterase (alpha-naphthyl butyrate) positivity that is inhibited by sodium fluoride indicates:

  1. A: Granulocytic differentiation
  2. B: Monocytic differentiation
  3. C: Erythroid differentiation
  4. D: Megakaryocytic differentiation
Show answer

Answer: B — Monocytic differentiation

Fluoride-sensitive NSE is a marker of monocytic cells (e.g., acute monocytic leukemia).

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q66 Leukemia · Easy

Terminal deoxynucleotidyl transferase (TdT) is a marker of:

  1. A: Mature plasma cells
  2. B: Precursor (immature) lymphoid cells
  3. C: Mature neutrophils
  4. D: Megakaryocytes
Show answer

Answer: B — Precursor (immature) lymphoid cells

TdT is a nuclear DNA polymerase in lymphoblasts; it is positive in most B-ALL and T-ALL.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q67 Leukemia · Medium

Which immunophenotype is typical of common precursor B-ALL?

  1. A: CD19+, CD10+, CD22+, cytoplasmic CD79a+, TdT+
  2. B: CD3+, CD7+, TdT+, CD19-
  3. C: CD5+, CD19+, CD23+, TdT-
  4. D: CD13+, CD33+, CD117+, MPO+
Show answer

Answer: A — CD19+, CD10+, CD22+, cytoplasmic CD79a+, TdT+

B-ALL expresses B-lineage markers (CD19, cCD79a, CD22) with CD10 and TdT. CD5/CD23 suggests CLL; CD13/33/117 suggests AML.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q68 Leukemia · Medium

Which marker is lineage-defining for T-lymphoblastic leukemia?

  1. A: CD19
  2. B: Cytoplasmic CD3
  3. C: CD33
  4. D: CD138
Show answer

Answer: B — Cytoplasmic CD3

Cytoplasmic (or surface) CD3 assigns T lineage; CD7 is sensitive but not specific.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q69 Leukemia · Medium

Which immunophenotype is typical of CLL?

  1. A: CD5+, CD19+, CD23+, dim CD20, weak surface Ig
  2. B: CD5+, CD19+, CD23-, cyclin D1+
  3. C: CD10+, CD19+, TdT+
  4. D: CD11c+, CD25+, CD103+, CD123+
Show answer

Answer: A — CD5+, CD19+, CD23+, dim CD20, weak surface Ig

CLL is CD5+/CD23+. Mantle cell lymphoma is CD5+ but CD23- and cyclin D1+. CD103/CD25/CD11c indicates hairy cell leukemia.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q70 Leukemia · Medium

Which marker set supports hairy cell leukemia?

  1. A: CD11c, CD25, CD103, CD123
  2. B: CD5, CD23, CD200
  3. C: CD10, TdT, CD34
  4. D: CD13, CD33, MPO
Show answer

Answer: A — CD11c, CD25, CD103, CD123

Classic HCL is CD11c+/CD25+/CD103+/CD123+, TRAP positive, and nearly always carries BRAF V600E.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q71 Leukemia · Easy

Chronic myeloid leukemia is defined by:

  1. A: JAK2 V617F mutation
  2. B: BCR::ABL1 fusion from t(9;22)
  3. C: PML::RARA fusion
  4. D: CALR mutation
Show answer

Answer: B — BCR::ABL1 fusion from t(9;22)

BCR::ABL1 (Philadelphia chromosome) is detected by karyotype, FISH or RT-PCR; quantitative RT-PCR monitors treatment response.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q72 Leukemia · Medium

Which blood picture is typical of chronic-phase CML?

  1. A: Pancytopenia with many blasts
  2. B: Lymphocytosis with smudge cells
  3. C: Teardrop cells with a dry tap
  4. D: Leukocytosis with all stages of granulocyte maturation and basophilia
Show answer

Answer: D — Leukocytosis with all stages of granulocyte maturation and basophilia

Chronic-phase CML shows a left shift with myelocyte and neutrophil peaks, basophilia, and usually under 10% blasts.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q73 Leukemia · Easy

In flow cytometry, side scatter (SSC) mainly reflects:

  1. A: Cell size
  2. B: Internal complexity or granularity of the cell
  3. C: DNA content
  4. D: Surface antigen expression
Show answer

Answer: B — Internal complexity or granularity of the cell

Forward scatter approximates size; side scatter reflects granularity. Antigens are detected with fluorochrome-labelled antibodies.

Reference: Henry's Clinical Diagnosis and Management by Laboratory Methods

Myeloproliferative neoplasms

Q74 Myeloproliferative neoplasms · Easy

Which mutation is found in about 95% of patients with polycythemia vera?

  1. A: JAK2 V617F
  2. B: BCR::ABL1
  3. C: CALR exon 9
  4. D: MPL W515L
Show answer

Answer: A — JAK2 V617F

JAK2 V617F is present in about 95% of PV; most remaining cases have JAK2 exon 12 mutations.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q75 Myeloproliferative neoplasms · Medium

Driver mutations in essential thrombocythemia include:

  1. A: BCR::ABL1 and PML::RARA
  2. B: JAK2, CALR and MPL
  3. C: FLT3 and NPM1
  4. D: PIGA and MYH9
Show answer

Answer: B — JAK2, CALR and MPL

JAK2, CALR or MPL mutations drive ET and primary myelofibrosis; about 10-15% are triple-negative.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Plasma cell neoplasms

Q76 Plasma cell neoplasms · Medium

Which surface marker is most specific for plasma cells on flow cytometry or immunohistochemistry?

  1. A: CD19
  2. B: CD3
  3. C: CD34
  4. D: CD138
Show answer

Answer: D — CD138

Plasma cells are CD138+ and CD38 bright, and usually lose CD19 and CD45 when neoplastic.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Lymphoma

Q77 Lymphoma · Medium

Reed-Sternberg cells of classic Hodgkin lymphoma are typically:

  1. A: CD15+ and CD30+, CD45-
  2. B: CD3+ and CD5+
  3. C: CD10+ and TdT+
  4. D: CD19+ and CD20 bright
Show answer

Answer: A — CD15+ and CD30+, CD45-

Classic HRS cells are CD30+, usually CD15+, and CD45 negative.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Q78 Lymphoma · Medium

Burkitt lymphoma is characterised by translocation of which gene?

  1. A: BCL2 (t(14;18))
  2. B: CCND1 (t(11;14))
  3. C: ABL1 (t(9;22))
  4. D: MYC (e.g., t(8;14))
Show answer

Answer: D — MYC (e.g., t(8;14))

MYC translocation drives a very high proliferation rate with a 'starry-sky' pattern. t(14;18) is follicular lymphoma; t(11;14) is mantle cell lymphoma.

Reference: WHO Classification of Haematolymphoid Tumours, 5th ed. (2022)

Hemostasis

Q79 Hemostasis · Easy

The prothrombin time (PT) assesses which factors?

  1. A: VII, X, V, II and fibrinogen
  2. B: XII, XI, IX and VIII
  3. C: XIII only
  4. D: Platelet function
Show answer

Answer: A — VII, X, V, II and fibrinogen

PT tests the extrinsic (VII) and common pathways (X, V, II, I).

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q80 Hemostasis · Medium

A healthy man with no bleeding history has an isolated prolonged APTT that corrects on mixing. Which deficiency is most likely?

  1. A: Factor XII
  2. B: Factor VIII
  3. C: Factor XIII
  4. D: Factor VII
Show answer

Answer: A — Factor XII

Contact factor (XII, prekallikrein, HMWK) deficiency prolongs APTT without bleeding. FXIII deficiency does not prolong APTT; FVII prolongs PT.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q81 Hemostasis · Easy

An isolated prolonged PT with normal APTT suggests deficiency of:

  1. A: Factor VII
  2. B: Factor VIII
  3. C: Factor IX
  4. D: Factor XII
Show answer

Answer: A — Factor VII

Only factor VII is unique to the PT. Early warfarin therapy and early vitamin K deficiency also cause this pattern because FVII has the shortest half-life.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q82 Hemostasis · Easy

A prolonged APTT corrects when mixed 1:1 with normal plasma. This suggests:

  1. A: A lupus anticoagulant
  2. B: A specific factor inhibitor
  3. C: A factor deficiency
  4. D: Heparin contamination
Show answer

Answer: C — A factor deficiency

Normal plasma supplies the missing factor. Failure to correct suggests an inhibitor.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q83 Hemostasis · Medium

Which test is commonly used to confirm a lupus anticoagulant?

  1. A: Thrombin time
  2. B: Dilute Russell viper venom time (dRVVT) with a phospholipid confirm step
  3. C: Factor XIII assay
  4. D: Platelet aggregation with ristocetin
Show answer

Answer: B — Dilute Russell viper venom time (dRVVT) with a phospholipid confirm step

LA testing needs screening, mixing and confirmation; the excess-phospholipid step shortens the clotting time. dRVVT and an LA-sensitive APTT are recommended.

Reference: Henry's Clinical Diagnosis and Management by Laboratory Methods

Q84 Hemostasis · Medium

A lupus anticoagulant is clinically associated with:

  1. A: Severe spontaneous bleeding
  2. B: Thrombocytosis
  3. C: Thrombosis and pregnancy loss
  4. D: Hemophilia A
Show answer

Answer: C — Thrombosis and pregnancy loss

Despite prolonging the APTT in vitro, LA is a risk factor for thrombosis (antiphospholipid syndrome).

Reference: Henry's Clinical Diagnosis and Management by Laboratory Methods

Q85 Hemostasis · Easy

Which coagulation factor is NOT vitamin K-dependent?

  1. A: Factor II
  2. B: Factor V
  3. C: Factor VII
  4. D: Factor X
Show answer

Answer: B — Factor V

Vitamin K-dependent proteins are II, VII, IX, X, protein C and protein S.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q86 Hemostasis · Easy

Warfarin therapy is monitored using:

  1. A: PT reported as INR
  2. B: APTT
  3. C: Anti-Xa activity
  4. D: Bleeding time
Show answer

Answer: A — PT reported as INR

INR = (patient PT / mean normal PT)^ISI, which standardises results between thromboplastin reagents.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q87 Hemostasis · Medium

Low-molecular-weight heparin, when monitoring is needed, is measured by:

  1. A: PT/INR
  2. B: Thrombin time
  3. C: Bleeding time
  4. D: Anti-Xa assay
Show answer

Answer: D — Anti-Xa assay

LMWH has little effect on APTT. Anti-Xa is used in renal impairment, pregnancy and extremes of weight. Unfractionated heparin may use APTT or anti-Xa.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q88 Hemostasis · Medium

Heparin contamination of a sample is suggested by:

  1. A: Normal thrombin time with prolonged reptilase time
  2. B: Prolonged thrombin time with normal reptilase time
  3. C: Isolated prolonged PT
  4. D: Shortened APTT
Show answer

Answer: B — Prolonged thrombin time with normal reptilase time

Heparin inhibits thrombin (prolonged TT) but not reptilase (batroxobin), which acts directly on fibrinogen.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q89 Hemostasis · Medium

Which pattern is typical of acute DIC?

  1. A: Normal PT and APTT, high platelets, normal D-dimer
  2. B: Isolated prolonged APTT, normal platelets
  3. C: Prolonged bleeding time only
  4. D: Prolonged PT and APTT, low fibrinogen, low platelets, high D-dimer
Show answer

Answer: D — Prolonged PT and APTT, low fibrinogen, low platelets, high D-dimer

Consumption of factors and platelets with secondary fibrinolysis produces this pattern; scoring systems (e.g., ISTH) combine these tests.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q90 Hemostasis · Hard

Which result best helps distinguish liver disease from DIC?

  1. A: Prothrombin time
  2. B: Fibrinogen level
  3. C: Platelet count
  4. D: Factor VIII level (normal or high in liver disease, low in DIC)
Show answer

Answer: D — Factor VIII level (normal or high in liver disease, low in DIC)

FVIII is made largely by endothelial cells, so it is preserved in liver disease but consumed in DIC.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q91 Hemostasis · Medium

Which pattern is typical of type 1 von Willebrand disease?

  1. A: Absent GPIIb/IIIa with normal VWF
  2. B: Reduced VWF antigen and activity, reduced or normal FVIII, normal platelet count
  3. C: Prolonged PT with normal APTT
  4. D: Giant platelets with absent ristocetin response corrected by normal plasma
Show answer

Answer: B — Reduced VWF antigen and activity, reduced or normal FVIII, normal platelet count

Type 1 is a partial quantitative VWF deficiency; APTT may be normal or prolonged. It is the most common type.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q92 Hemostasis · Hard

Platelet agglutination with ristocetin is absent and is NOT corrected by adding normal plasma. Platelets are large. The diagnosis is:

  1. A: Bernard-Soulier syndrome
  2. B: von Willebrand disease
  3. C: Glanzmann thrombasthenia
  4. D: Aspirin effect
Show answer

Answer: A — Bernard-Soulier syndrome

BSS lacks the GPIb-IX-V receptor, so adding normal VWF does not help. In vWD, normal plasma corrects the defect.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q93 Hemostasis · Medium

Absent platelet aggregation with ADP, collagen and epinephrine but normal ristocetin response suggests:

  1. A: Bernard-Soulier syndrome
  2. B: Glanzmann thrombasthenia
  3. C: von Willebrand disease
  4. D: Storage pool disease
Show answer

Answer: B — Glanzmann thrombasthenia

Glanzmann thrombasthenia is deficiency of GPIIb/IIIa (integrin alphaIIb beta3), the fibrinogen receptor.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q94 Hemostasis · Medium

A neonate bleeds from the umbilical stump. PT, APTT, TT and platelet count are normal. Which test is indicated?

  1. A: Factor VIII assay
  2. B: Mixing study
  3. C: Anti-Xa assay
  4. D: Factor XIII activity (or clot solubility test)
Show answer

Answer: D — Factor XIII activity (or clot solubility test)

FXIII cross-links fibrin and does not affect routine clotting times. Delayed bleeding and umbilical stump bleeding are classic.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q95 Hemostasis · Hard

Platelets fall by 60% on day 7 of unfractionated heparin. The anti-PF4/heparin ELISA is positive. Which test is the functional gold standard for confirmation?

  1. A: D-dimer
  2. B: Bleeding time
  3. C: Platelet count on a citrate sample
  4. D: Serotonin release assay
Show answer

Answer: D — Serotonin release assay

HIT is screened with the 4Ts score and immunoassay; SRA (or HIPA) confirms platelet-activating antibodies.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q96 Hemostasis · Easy

The recommended anticoagulant for routine coagulation testing is:

  1. A: K2-EDTA
  2. B: Lithium heparin
  3. C: 3.2% sodium citrate, 9 parts blood to 1 part anticoagulant
  4. D: Sodium fluoride/potassium oxalate
Show answer

Answer: C — 3.2% sodium citrate, 9 parts blood to 1 part anticoagulant

Citrate chelates calcium reversibly; the 9:1 ratio must be maintained.

Reference: CLSI H21 - Collection, Transport, and Processing of Blood Specimens for Plasma-Based Coagulation Assays

Q97 Hemostasis · Easy

What is the effect of an underfilled citrate tube on PT and APTT?

  1. A: Falsely prolonged results
  2. B: Falsely shortened results
  3. C: No effect
  4. D: Only platelet count is affected
Show answer

Answer: A — Falsely prolonged results

Excess citrate relative to plasma binds the calcium added in the test, prolonging clotting times. Reject underfilled tubes.

Reference: CLSI H21 - Collection, Transport, and Processing of Blood Specimens for Plasma-Based Coagulation Assays

Q98 Hemostasis · Hard

A patient's hematocrit is 62%. What adjustment is needed for coagulation sample collection?

  1. A: Increase the volume of citrate in the tube
  2. B: Use an EDTA tube instead
  3. C: Reduce the volume of citrate in the tube
  4. D: No adjustment is needed
Show answer

Answer: C — Reduce the volume of citrate in the tube

With hematocrit above 55%, plasma volume is low and citrate is relatively in excess, so citrate volume is reduced using the CLSI formula.

Reference: CLSI H21 - Collection, Transport, and Processing of Blood Specimens for Plasma-Based Coagulation Assays

Q99 Hemostasis · Medium

The main clinical value of a D-dimer test in suspected venous thromboembolism is:

  1. A: A positive result confirms VTE
  2. B: It identifies the location of the clot
  3. C: It monitors warfarin therapy
  4. D: A negative result helps exclude VTE in patients with low pretest probability
Show answer

Answer: D — A negative result helps exclude VTE in patients with low pretest probability

D-dimer is sensitive but not specific; it rises in infection, pregnancy, surgery and malignancy.

Reference: Henry's Clinical Diagnosis and Management by Laboratory Methods

Q100 Hemostasis · Medium

Antithrombin acts mainly by:

  1. A: Inactivating factors Va and VIIIa
  2. B: Blocking vitamin K recycling
  3. C: Degrading fibrin into D-dimer
  4. D: Inhibiting thrombin and factor Xa, accelerated by heparin
Show answer

Answer: D — Inhibiting thrombin and factor Xa, accelerated by heparin

Heparin accelerates antithrombin activity about 1000-fold. Protein C/S inactivates Va and VIIIa; warfarin blocks vitamin K recycling.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q101 Hemostasis · Medium

Factor V Leiden increases thrombotic risk because factor V becomes:

  1. A: Unable to bind calcium
  2. B: Resistant to inactivation by activated protein C
  3. C: Deficient in plasma
  4. D: Resistant to thrombin activation
Show answer

Answer: B — Resistant to inactivation by activated protein C

The R506Q mutation removes an APC cleavage site (APC resistance). It is the most common inherited thrombophilia in people of European ancestry.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Preanalytical errors

Q102 Preanalytical errors · Medium

An EDTA sample shows a platelet count of 40 x10^9/L, but the smear shows large platelet clumps. What is the best next step?

  1. A: Recollect in sodium citrate and correct the count for dilution
  2. B: Report the count as severe thrombocytopenia
  3. C: Transfuse platelets
  4. D: Repeat on the same EDTA sample after refrigeration
Show answer

Answer: A — Recollect in sodium citrate and correct the count for dilution

EDTA-dependent pseudothrombocytopenia is in vitro clumping. A citrate sample (count multiplied by about 1.1 for dilution) or examining the smear gives a better estimate.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q103 Preanalytical errors · Medium

A CBC shows low RBC count, very high MCV and MCHC, and grainy agglutinates on the smear. What should be done?

  1. A: Dilute the sample with water
  2. B: Report the results as macrocytic anemia
  3. C: Warm the sample to 37 C and re-run
  4. D: Add heparin to the sample
Show answer

Answer: C — Warm the sample to 37 C and re-run

Cold agglutinins clump RBCs at room temperature; clumps are counted as single large cells. Warming disperses them.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q104 Preanalytical errors · Medium

Severe lipemia in an EDTA sample is most likely to falsely increase:

  1. A: RBC count
  2. B: Hemoglobin and MCH/MCHC
  3. C: Platelet count only
  4. D: Hematocrit
Show answer

Answer: B — Hemoglobin and MCH/MCHC

Turbidity increases light absorbance in the Hb measurement. Plasma replacement with diluent corrects it.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Q105 Preanalytical errors · Medium

Which factor falsely DECREASES the ESR?

  1. A: Tilting the ESR tube
  2. B: Anemia
  3. C: Marked poikilocytosis such as sickle cells
  4. D: High room temperature
Show answer

Answer: C — Marked poikilocytosis such as sickle cells

Abnormal RBC shapes cannot form rouleaux, so they settle slowly. A tilted tube, anemia and high temperature increase the ESR.

Reference: Rodak's Hematology: Clinical Principles and Applications (Keohane et al.)

Quality control

Q106 Quality control · Easy

The Westgard 1-3s rule is violated when:

  1. A: Two consecutive control results exceed 2 SD on the same side
  2. B: One control result exceeds the mean plus or minus 3 SD
  3. C: Ten consecutive results fall on one side of the mean
  4. D: One control result exceeds the mean plus or minus 2 SD
Show answer

Answer: B — One control result exceeds the mean plus or minus 3 SD

1-3s is a rejection rule that mainly detects random error. 1-2s is a warning rule.

Reference: Westgard JO - Basic QC Practices

Q107 Quality control · Medium

Two consecutive control results exceed +2 SD. Which rule is violated and what type of error does it suggest?

  1. A: R-4s; random error
  2. B: 2-2s; systematic error
  3. C: 1-2s; no error
  4. D: 10x; random error
Show answer

Answer: B — 2-2s; systematic error

2-2s detects systematic error, such as calibration drift or reagent deterioration.

Reference: Westgard JO - Basic QC Practices

Q108 Quality control · Medium

In one run, the level 1 control is +2.5 SD and the level 2 control is -2.2 SD. Which rule is violated?

  1. A: R-4s (random error)
  2. B: 2-2s (systematic error)
  3. C: 10x (systematic error)
  4. D: 4-1s (systematic error)
Show answer

Answer: A — R-4s (random error)

R-4s applies when two controls in the same run differ by more than 4 SD in opposite directions, indicating random error.

Reference: Westgard JO - Basic QC Practices

Q109 Quality control · Medium

Ten consecutive control results fall on the same side of the mean, all within 2 SD. This indicates:

  1. A: Random error (R-4s rule)
  2. B: Acceptable performance with no action
  3. C: A 1-3s violation
  4. D: A systematic shift (10x rule)
Show answer

Answer: D — A systematic shift (10x rule)

The 10x rule detects a shift or bias, e.g., a new reagent lot or calibration change.

Reference: Westgard JO - Basic QC Practices

Q110 Quality control · Easy

In the multirule procedure, the 1-2s rule is used as a:

  1. A: Rejection rule
  2. B: Rule for detecting long-term trends only
  3. C: Calibration acceptance rule
  4. D: Warning rule that triggers inspection with other rules
Show answer

Answer: D — Warning rule that triggers inspection with other rules

A single control beyond 2 SD occurs by chance in about 5% of runs, so it prompts checking with the other rules.

Reference: Westgard JO - Basic QC Practices

Transfusion

Q111 Transfusion · Easy

The Kleihauer-Betke test is used to:

  1. A: Detect sickle cell trait
  2. B: Measure osmotic fragility
  3. C: Detect cold agglutinins
  4. D: Quantify fetomaternal hemorrhage to calculate the RhIG dose
Show answer

Answer: D — Quantify fetomaternal hemorrhage to calculate the RhIG dose

Fetal RBCs (HbF) resist acid elution and stain pink while adult cells appear as ghosts. Flow cytometry is an alternative.

Reference: AABB Technical Manual

Q112 Transfusion · Easy

Transfusion-associated graft-versus-host disease is prevented by:

  1. A: Washing red cells
  2. B: Warming the blood
  3. C: Irradiating cellular blood components
  4. D: Using fresh frozen plasma
Show answer

Answer: C — Irradiating cellular blood components

Irradiation (or pathogen reduction) inactivates donor T lymphocytes. Leukoreduction alone is not sufficient.

Reference: AABB Technical Manual

Q113 Transfusion · Medium

Transfusion-related acute lung injury is most often caused by:

  1. A: ABO incompatibility
  2. B: Donor anti-HLA or anti-HNA antibodies
  3. C: Bacterial contamination
  4. D: Iron overload
Show answer

Answer: B — Donor anti-HLA or anti-HNA antibodies

Donor leukocyte antibodies activate recipient neutrophils in the lung, with onset within 6 hours of transfusion.

Reference: AABB Technical Manual