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Ciulla 4th Edition Hematology Review Questions

Bachelor in Medical Laboratory Science (University of Pangasinan)

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CIULLA HEMATOLOGY REVIEW QUESTIONS

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
B. Apoptosis
Hematopoiesis C. Cellular senescence
1. What is the first type of cell produced by the developing embryo? D. Terminal differentiation
A. Erythrocyte
B. Granulocyte 11. In what area of the bone marrow does hematopoiesis take place?
C. Lymphocyte A. Cords
D. Thrombocyte B. Endosteum
C. Endothelium
2. What percentage of tissue located in the bone marrow cavities of adults is D. Sinuses
fat?
A. 10% 12. Bone marrow cellularity refers to the ratio of
B. 25% A. Red cell precursors to white cell precursors
C. 50% B. Hematopoietic tissue to adipose tissue
D. 75% C. Granulocytic cells to erythrocytic cells
D. Extravascular tissue to intravascular tissue
3. Which of the following is not characteristic of pluripotent hematopoietic
stem cells? 13. Interleukins and colony stimulating factors are cytokines produced by
A. Possess self-renewal ability A. B lymphocytes and erythrocytes
B. Produce progenitor cells committed to a single cell lineage B. Erythrocytes and thrombocytes
C. Express the stem cell marker CD 13 C. Monocytes and T lymphocytes
D. Are morphologically unrecognizable D. Neutrophils and monocytes

4. In an adult, what are the two best areas for obtaining active bone marrow 14. What is the approximate total blood volume in an adult?
by aspiration? A. 1L
A. Vertebra, tibia B. 2L
B. Sternum, vertebra C. 6L
C. Anterior iliac crest, tibia D. 12L
D. Posterior iliac crest, sternum
15. The myeloid progenitor cell can produce cells committed to
5. What is the normal ratio of myeloid to erythroid precursors in bone A. Granulocytic, erythrocytic, monocytic, or megakaryocytic lineages
marrow (M:E ratio)? B. Granulocytic, monocytic, lymphocytic, or megakaryocytic lineages
A. 1:1 C. Erythrocytic, granulocytic, monocytic, or lymphocytic lineages
B. 1:3 D. Erythrocytic, granulocytic, lymphocytic, or megakaryocytic lineages
C. 4:1
D. 8:1 16. The largest hematopoietic cells in normal bone marrow are
A. Osteoblasts
6. Which of the following does not accurately describe hematopoietic growth B. Osteoclasts
factors? C. Megakaryocytes
A. Bind to target cell receptors to express activity D. Plasma cells
B. Action of majority is lineage restricted
C. May promote or suppress cell death 17. When evaluating a bone marrow aspirate smear, which finding is
D. Can stimulate or inhibit cell proliferation considered abnormal?
A. A predominance of granulocyte precursors as compared to nucleated red
7. In the third month of gestation, what is the primary site of hematopoiesis? cells
A. Liver B. Detection of stainable iron in macrophages and erythroid precursors with
B. Marrow of long bones Prussian blue
C. Spleen C. An average of three megakaryocytes seen per low power (10X) field
D. Yolk sac D. The presence of 10% myeloblasts on the cell differential count

8. The mechanism that relays information about tissue oxygen levels to 18. As most blood cell lines mature, which of the following is characteristic?
erythropoietin-producing sites is located in the A. Cell diameter increases
A. Brain B. Nucleus to cytoplasm ratio (N:C) decreases
B. Kidney C. Nuclear chromatin becomes less condensed
C. Liver D. Basophilia of the cytoplasm increases
D. Spleen
19. Which of the following describes thrombopoietin (TPO)?
9. Antigen-independent lymphopoiesis occurs in primary lymphoid tissue A. Renal hormone that regulates marrow red cell production
located in the B. Marrow hormone secreted by developing megakaryoblasts
A. Liver and kidney C. Hormone produced by the liver that stimulates megakaryopoiesis
B. Spleen and lymph nodes D. Pituitary hormone that controls platelet sequestration by the spleen
C. Peyer's patches and spleen
D. Thymus and bone marrow 20. When the hepatic phase of fetal life is reactivated in an adult,
hematopoiesis can be termed
10. Programmed cell death is called A. Myeloid or medullary
A. Necrosis B. Myeloid metaplasia or extramedullary
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CIULLA HEMATOLOGY REVIEW QUESTIONS

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
C. Myelophthisis or myelodysplasia D. Red cells with intracellular rod-shaped crystals
D. Mesoblastic or mesenchymal
31. The red cells found in lead poisoning characteristically exhibit coarse
granules composed of that are reported as.
Erythrocytes A. Precipitated hemoglobin; Pappenheimer bodies
21. What is the average life span of a normal red blood cell? B. Aggregated ribosomes; basophilic stippling
A. 1 day C. Nuclear fragments; Pappenheimer bodies
B. 10 days D. Excess iron deposits; basophilic stippling
C. 60 days
D. 120 days 32. Rouleaux of red blood cells when seen in the monolayer of a blood smear
is characteristic of
22. The Na+-K+ cation pump is an important mechanism in keeping the red A. Hypersplenism
blood cell intact. Its function is to maintain a high level of B. Hypogammaglobulinemia
A. Intracellular Na+ C. Cold hemagglutinin disease
B. Intracellular K+ D. Multiple myeloma
C. Plasma Na+
D. Plasma K+ 33. Which of the following is most frequently associated with the inclusion
23. Which of the following depicts the structure of the hemoglobin molecule? bodies seen in Color Plate 1?
A. Two heme groups, two globin chains
B. Four heme groups, two globin chains
C. Two heme groups, four globin chains
D. Four heme groups, four globin chains

24. Which of the following describes the process known as culling?

A. Release of red cells from the bone marrow
B. Binding of free hemoglobin by transport proteins
C. Incorporation of iron into proto porphyrin IX
D. Removal of abnormal red cells by the spleen

25. Hemoglobin forms that are incapable of oxygen transport include

A. Deoxyhemoglobin and oxyhemoglobin
B. Oxyhemoglobin and carboxyhemoglobin
C. Carboxyhemoglobin and methemoglobin
D. Methemoglobin and deoxyhemoglobin A. Iron overload state
B. Post-transfusion
26. The majority of iron found in an adult is a constituent of C. Post-splenectomy
A. Ferritin D. Iron-deficient state
B. Myoglobin
C. Hemoglobin 34. Which of the following statements about iron absorption is true?
D. Peroxidase A. Absorption occurs in the ileum.
B. The mucosal cell always absorbs the correct amount of iron to meet needs.
27. A senescent red blood cell is one that has C. Absorption increases when erythropoietic activity increases.
A. Been hemolyzed D. Alkaline pH favors absorption.
B. Lived its life span
C. Become deformed 35. What term describes a mature red blood cell that contains iron granules
D. Lost its mitochondria or deposits?
A. Siderosome
28. What red cell morphologic abnormality is described by the term B. Sideroblast
"poikilocytosis"? C. Ringed sideroblast
A. Variations in size D. Siderocyte
B. Deviations from normal shape
C. Presence of inclusions 36. Which of the following is associated with a "shift to the left" in the oxygen
D. Alterations in hemoglobin concentration dissociation curve of hemoglobin?
A. Decreased pH and elevated temperature
29. Howell-Jolly bodies are composed of B. Decreased oxygen affinity
A. DNA C. Decreased oxygen release
B. Iron D. Presence of 2,3-bisphosphoglycerate (2,3-BPG)
C. Reticulura
D. RNA 37. Which of the following statements does not characterize erythropoietin
(EPO)?
30. When spherocytes are reported, what is observed on the peripheral A. Transforms the CFU-E into the earliest recognizable RBC precursor
blood smear? B. Increases the rate of red blood cell production by the bone marrow
A. Red cells without a central pallor C. Shortens the maturation time of developing erythroid precursors
B. Red cells with blunt projections D. Decreases stimulation of erythropoiesis when cellular hypoxia increases
C. Red cells with sharp projections
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CIULLA HEMATOLOGY REVIEW QUESTIONS

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
38. Which of the following factors will result in an immediate increase in B. Altered membrane lipids
oxygen delivery to the tissues? C. Mechanical trauma
A. Increased pH D. Polymerization of hemoglobin molecules
B. High altitudes
C. Increased hemoglobin binding of 2,3-BPG 46. Which erythrocyte metabolic pathway generates adenosine triphosphate
D. Increased renal release of erythropoietin (ATP) via glycolysis?
A. Embden-Meyerhof
39. Periods of intense erythropoietin activity cause premature release of B. Hexose monophosphate
marrow reticulocytes into the blood. Which of the following is not true of C. Rapoport-Luebering
these early reticulocytes? D. Methemoglobin reductase
A. Loss of residual RNA occurs immediately upon marrow release
B. Circulate longer than usual before reaching maturity 47. Which of the following red blood cell precursors is the last stage to
C. May be termed shift or stress reticulocytes undergo mitosis?
D. Show diffuse basophilia with Wright's stain A. Pronormoblast
B. Basophilic normoblast
40. Which of the following inclusions is only visible with supravital staining? C. Polychromatophilic normoblast
A. Basophilic stippling D. Orthochromic normoblast
B. Cabot rings
C. Heinz bodies 48. The major adult hemoglobin requires the synthesis of alpha-globin chains
D. Pappenheimer bodies and
A. Beta-globin chains
41. The presence of schistocytes on the peripheral blood smear is commonly B. Delta-globin chains
associated with C. Epsilon-globin chains
A. Increased iron mobilization D. Gamma-globin chains
B. Increased red cell destruction
C. Decreased erythropoietin activity 49. Defective nuclear maturation commonly results in the production of red
D. Decreased red cell proliferation cells that are
A. Normocytic
42. Which of the following may be a sign of accelerated bone marrow B. Hypochromic
erythropoiesis? C. Macrocytic
A. Hypercellular marrow with a decreased number of RBC precursors D. Microcytic
B. Bone marrow M:E ratio of 6:1
C. Nucleated red cells in the peripheral circulation 50. The major storage form of iron is
D. Low erythrocyte, hemoglobin, and hematocrit levels A. Ferritin
B. Transferrin
43. Microcytic, hypochromic red cells are most often associated with C. Hemosiderin
impaired A. DNA synthesis D. Hemachromatin
B. RNA metabolism
C. Hemoglobin synthesis 51. The red cells observed on a peripheral blood smear show extreme
D. Enzyme metabolism anisocytosis with an equal number of macrocytes and microcytes. Which of
the following values correlate with this finding?
44. When in bone marrow, the nucleated red cells Color Plate 2 would be A. MCV 108.0 fL, RDW 14.0%
staged as B. MCV 90.0 fL, RDW 25.0%
C. MCV 75.0 fL, RDW 16.0%
D. MCV 88.0 fL, RDW 12.0%

52. Excessive extravascular red cell destruction is associated with

A. Hemoglobinemia
B. Bilirubinemia
C. Hemoglobinuria
D. Hemosiderinuria

53. Which protein is primarily responsible for transport of hemoglobin dimers

resulting from intravascular hemolysis?
A. Hemopexin
B. Albumin
A. Basophilic normoblasts C. Hemosiderin
B. Polychromatophilic normoblasts D. Haptoglobin
C. Orthochromic normoblasts
D. Pronormoblasts 54. The morphologic abnormality characteristically found in
hemoglobinopathies is
45. When acanthocytes are found on the blood smear, it is usually the result A. Elliptocytes
of B. Dacryocytes
A. Abnormal membrane permeability C. Codocytes
D. Discocytes
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CIULLA HEMATOLOGY REVIEW QUESTIONS

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55. Where do the early and late stages of heme synthesis occur?
A. On ribosomes
B. In mitochondria
C. In cytoplasm
D. In nucleoli

56. Spectrin is a protein that occupies a major role in

A. Red cell membrane structure
B. Reducing ferric iron
C. Red cell transport and removal of CC>2
D. Iron recovery during hemoglobin degradation

57. What is the function of reduced glutathione (GSH) in the red blood cell?
A. Promotes Kreb's cycle activity
B. Maintains anion balance during the "chloride shift"
C. Neutralizes intracellular oxidants that accumulate A. Hemoglobin S will be revealed by electrophoresis.
D. Prevents oxygen uptake by hemoglobin B. Tests to confirm iron deficiency should be ordered.
C. An intrinsic hereditary defect of red cells should be suspected.
58. What does measuring the total iron binding capacity (TIBC) represent? D. The anemia is secondary to spleen and gallbladder disorders.
A. Amount of free iron in serum
B. Circulating protein-bound iron 65. A 9-month-old male was seen in the Emergency Department with a femur
C. Amount of iron that transferrin can bind fracture that had occurred from a fall down the stairs. Upon physical
D. Indirect measurement of iron stores examination, the physician noted hepatosplenomegaly, extreme pallor, and a
59. Serum ferritin is a good indicator of the amount of slight arrhythmia. A complete blood count revealed the following:
A. Cytochrome iron WBC 12.2x109/L (12.2x103/uL)
B. Storage iron RBC 3.05x1012/L (3.05x106/uL)
C. Hemoglobin iron Hemoglobin 61 g/L (6.1 g/dL)
D. Transferrin saturation Hematocrit 0.20 L/L (20%)
MCV 65.5 fL
60. Fetal hemoglobin differs from adult hemoglobin in that hemoglobin F MCH 20 pg
A. Has a lower oxygen affinity MCHC 305 g/L (30.5 g/dL)
B. Resists elution from red cells with acid solutions RDW 25%
C. Is no longer synthesized after birth in a normal individual The Wright stained blood smear showed the findings seen in Color Plate 4B.
D. Has four gamma-globin chains Hemoglobin electrophoresis was ordered with results as follows:

Erythrocyte Disorders
61. Impaired DNA metabolism is characteristic of
A. Hemoglobin C disease
B. Iron-deficiency anemia
C. Sideroblastic anemia
D. Megaloblastic anemia

62. Which of the following is associated with glucose-6-phosphate

dehydrogenase (G6PD) deficiency?
A. G6PD gene is located on the X chromosome.
B. Ongoing intravascular hemolysis occurs.
C. All circulating red cells, including reticulocytes, lack enzyme activity.
D. Splenectomy can relieve the rate of red cell destruction.
Hgb A 0%
Hgb A2 3%
63. In regard to variant hemoglobin E, a2 B2 26 Glu ------- Lys, which of the
Hgb F 97%
following statements is false?
Which condition is most likely causing the hematologic abnormalities?
A. There are two normal alpha chains.
A. Alpha-thalassemia major
B. Glutamic acid replaces lysine on position 26 of the beta chains.
B. Cooley beta-thalassemia major
C. Hemoglobin E is the second most common hemoglobin variant known.
C. Hemoglobin H disease
D. Glutamic acid is normally found at position 26 of the beta chain.
D. Hereditary persistence of hemoglobin F
64. Color Plate 3B shows the peripheral blood of a 16-year-old female with a
66. A 14-year-old African-American male was seen in the clinic for abdominal
sporadic history of dizzy spells, fainting, and jaundice. This patient also had a
pain. A complete blood count revealed the following:
history of periodic abdominal pain related to gallstones. Upon physical
WBC 7.0x109/L (7.0x103/uL)
examination, she exhibited mild splenomegaly. Her hemoglobin was 107 g/L
RBC 2.90x1012/L (2.90x106/uL)
(10.7 g/dL), hematocrit was 0.32 L/L (32%), red cell indices were normal, and
Hemoglobin 85 g/L (8.5 g/dL)
the direct antiglobulin test was negative. Based on history and peripheral
Hematocrit 0.25 L/L (25%)
blood morphology, which of the following statements is most likely true?

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CIULLA HEMATOLOGY REVIEW QUESTIONS

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
MCV 86.2 fL
MCH 29.3 pg 71. Which of the following blood findings does not correlate with the
MCHC 340 g/L (34.0 g/dL) presence of ringed sideroblasts in the bone marrow?
RDW 21% A. Pappenheimer bodies
The peripheral smear showed the red blood cell morphology seen in Color B. Basophilic stippling
Plate 5. What condition is suggested by these findings? C. Increased total iron-binding capacity
D. Increased percent transferrin saturation

72. Which of the following conditions is not usually associated with marked
reticulocytosis?
A. Four days after a major hemorrhage
B. Drug-induced autoimmune hemolytic anemia
C. Sickle cell anemia
D. Pernicious anemia

73. Hereditary stomatocytosis is manifested physiologically by changes in

A. Hemoglobin oxygen affinity
B. Membrane cation permeability
C. Efficiency of hemoglobin reduction
D. Glycolytic ATP production
A. Hemoglobin E disease
B. Hemoglobin S disease
74. In addition to an increase in red blood cells, which of the following is
C. Hemoglobin SC disease
characteristic of polycythemia vera?
D. Hemoglobin C disease
A. Decreased platelets, decreased granulocytes, decreased erythropoietin
level
67. Pica is most commonly associated with which of the following conditions?
B. Decreased platelets, decreased granulocytes, increased erythropoietin
A. Pyridoxine deficiency
level C. Increased platelets, increased granulocytes, increased erythropoietin
B. Lack of erythrocyte folate
level D. Increased platelets, increased granulocytes, decreased erythropoietin
C. Iron deficiency
level
D. Porphyrias

75. Which of the following is not characteristic of aplastic anemia?

68. Of the following, the leading cause of folate deficiency is
A. Extramedullary hematopoiesis
A. Increased requirements
B. Bone marrow hypoplasia
B. Dietary insufficiency
C. Absolute reticulocytopenia
C. Drug inhibition
D. Blood findings of pancytopenia
D. Malabsorption

76. What values would you expect to obtain on hemoglobin and hematocrit
69. Which of the following statements about sickle cell syndromes is false?
determinations done immediately after a major hemorrhage, if hemoglobin
A. Asplenism may result from repeated sickling crises in the homozygous
and hematocrit values were normal prior to the hemorrhage?
state. B. Heterozygous persons may be partly protected from infection by
A. Both normal
falciparum malaria.
B. Both decreased
C. Hemoglobin S is more soluble in dithionite than is normal hemoglobin.
C. Hemoglobin decreased, hematocrit normal
D. Trait conditions are generally asymptomatic with no sickle cell formation.
D. Hemoglobin normal, hematocrit decreased
70. The findings seen in Color Plate 6, what can be found in patients with
77. Results from a 1-day-old infant include a
microangiopathic hemolytic anemia (MAHA). Which of the following
hemoglobin of 201 g/L (20.1 g/dL)
conditions could not be responsible for this type of red cell destruction?
hematocrit of 0.60 L/L (60.0%)
MCV of 110.2 fL
4 nucleated red cells/100 WBCs.
How should these results be interpreted?
A. The elevated hemoglobin and hematocrit values indicate possible
dehydration.
B. The nucleated red cells suggest accelerated erythropoiesis due to a
hemolytic process.
C. Testing should be done to identify the cause of the macrocytosis.
D. No further testing is indicated.

78. When viewing Color Plate 7, the red blood cells with a single elongated
projection are known as _________________ and may be seen in
_________________
A. Disseminated intravascular coagulation (DIG)
B. Hemolytic uremic syndrome (HUS)
C. Thrombotic thrombocytopenic purpura (TTP)
D. Idiopathic thrombocytopenic purpura (ITP)

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CIULLA HEMATOLOGY REVIEW QUESTIONS

BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
86. Which of the following would be useful in identifying the cause of the
blood profile seen in Color Plate 8?

A. Acanthocytes; liver disease

B. Echinocytes; liver disease A. Osmotic fragility test
C. Drepanocytes; myelofibrosis B. Reticulocyte count
D. Dacryocytes; myelofibrosis C. Direct antiglobulin test
D. Urine urobilinogen level
79. A patient with normocytic, normochromic anemia secondary to small cell
carcinoma may be exhibiting an anemia designated as 87. Which of the following conditions is not associated with the presence of
A. Hemolytic schistocytes and spherocytes?
B. Megaloblastic A. Clostridial septicemia
C. Myelophthisic B. Prosthetic heart valves
D. Sideroblastic C. Severe thermal burns
D. Aplastic anemia
80. Idiopathic aplastic anemia is best defined as a form of anemia that
A. Has no identifiable cause 88. A 30-year-old woman who has been vomiting for 3 days has a
B. Is caused by a physician's treatment hemoglobin value of 180 g/L (18.0 g/dL)
C. Follows exposure to ionizing radiation hematocrit of 0.54 L/L (54.0%)
D. Develops after a viral infection Her results suggest the presence of
A. Absolute erythrocytosis
81. Which of the following is a true red blood cell aplasia? B. Primary polycythemia
A. Marrow replacement anemia C. Secondary polycythemia
B. Fanconi anemia D. Relative polycythemia
C. Diamond-Blackfan anemia
D. Donath-Landsteiner anemia 89. An excessive accumulation of iron in body tissues is called
A. Hemochromatosis
82. Which of the following is not a cause of absolute secondary B. Erythroblastosis
erythrocytosis? A. Defective cardiac or pulmonary function C. Megaloblastosis
B. High-altitude adjustment D. Acrocyanosis
C. Dehydration secondary to diuretic use
D. Hemoglobins with increased oxygen affinity 90. Abetalipoproteinemia is characterized by mild anemia and numerous on
the peripheral blood smear.
83. A cellulose acetate hemoglobin electrophoresis (alkaline pH), performed A. Acanthocytes
on the blood of a stillborn infant, revealed a single band that migrated farther B. Elliptocytes
toward the anode than did the Hb A control. What is the most likely C. Echinocytes
composition of the stillborn infant's hemoglobin? D. Stomatocytes
A. Four beta chains
B. Four gamma chains 91. What is the most common cause of iron deficiency?
C. Two alpha and two beta chains A. Bleeding
D. Two alpha and two gamma chains B. Gastrectomy
C. Inadequate diet
84. The most likely cause of the stillborn infant's condition in question 83 is D. Intestinal malabsorption
A. Erythroblastosis fetalis
B. Rh hemolytic disease of the fetus 92. Which of the following does not characterize beta-thalassemia major?
C. Hydrops fetalis A. Transfusion-dependent anemia
D. ABO hemolytic disease of the newborn B. Decreased alpha chains result in excess beta chains.
C. Iron chelation therapy is necessary.
85. Which of the following conditions show similar CBC and blood smear D. Common in persons of Mediterranean ancestry
findings?
A. Beta-thalassemia major and minor 93. In the anemia of chronic disease, what are the usual serum iron and
B. Folic acid and vitamin B12 deficiencies transferrin levels?
C. Acute and chronic blood loss A. Serum iron decreased, transferrin decreased
D. Sickle cell disease and trait B. Serum iron decreased, transferrin increased
C. Serum iron normal, transferrin normal
D. Serum iron increased, transferrin increased

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BACHELOR OF SCIENCE IN MEDICAL LABORATORY SCIENCE
D. Precipitation of denatured hemoglobin
94. In children, the most important effect of lead poisoning is on the
A. Liver 102. In clinically severe hereditary spherocytosis, which of the following
B. Kidney findings would not be found post-splenectomy?
C. Neurologic system A. Rise in the red cell count and hemoglobin level
D. Development of erythrocytes B. Higher number of circulating reticulocytes
C. Increased number of Howell-Jolly bodies
95. Which of the following would not result in the dual population of red cells D. Transient elevation in the platelet count
represented in Color Plate 9?
103. Which of the following laboratory results is not consistent with
accelerated red cell destruction?
A. Increased serum bilirubin
B. Increased plasma hemoglobin
C. Increased serum lactate dehydrogenase (LD)
D. Increased serum haptoglobin

104. Acquired hemolytic anemias are usually due to

A. Extracorpuscular factors
A. Blood transfusion
B. Defects within the bone marrow
B. Oral iron therapy
C. Intracellular factors
C. Spleen removal
D. Changes in hemoglobin stability
D. Coexisting deficiencies

105. The antibody associated with paroxysmal cold hemoglobinuria shows

96. What is the most likely genetic defect in the hemoglobin of cells seen in
specificity for
Color Plate 10?
A. ABO antigens
A. Substitution of valine for glutamic acid in position 6 of the alpha-globin
B. I antigens
chain B. Substitution of valine for glutamic acid in position 6 of the beta-
C. P antigens
globin chain C. Substitution of lysine for glutamic acid in position 6 of the
D. Rh antigens
alpha-globin chain D. Substitution of lysine for glutamic acid in position 6 of
the beta-globin chain
106. A 69-year-old male is admitted with pallor, mild tachycardia, and
difficulty walking because of numbness in the extremities. His CBC reveals a
97. On what is the classification of sickle cell trait versus sickle cell disease
hemoglo bin of 78 g/L (7.8 g/dL), a hematocrit of 0.25 L/L (25.0%), and MCV
based?
of 118.5 fL. This patient's symptoms and the blood findings seen in Color
A. Severity of the clinical symptoms
Plate 11, are most suggestive of anemia due to a lack of
B. Number of irreversibly sickled cells (ISCs)
C. Level of compensatory hemoglobin F
D. Percentage of hemoglobin S on electrophoresis

98. Which of the following is the most appropriate treatment for sickle cell
anemia?
A. Hydroxyurea
B. Supportive therapy
C. Hyperbaric oxygen
D. Iron
A. Folic acid
99. Which of the following values can be used to indicate the presence of a B. Vitamin B12
hemolytic anemia? C. Vitamin B6
A. Hemoglobin level D. Ascorbic acid
B. Hematocrit level
C. Erythrocyte count 107. A clinical laboratory scientist examined a Wright's stained
D. Reticulocyte count peripheral smear and saw what appeared to be small, dark-staining
granules in the mature erythrocytes. A second smear was stained
100. A pre-operative, 20-year-old female has a mild microcytic anemia, with with Prussian blue and a positive result was obtained. Based on this
target cells and stippled red cells observed on the blood smear. Her information, which of the following would you expect to be
hemoglobin A2 level is quantified at 5%. What do these findings suggest?
abnormal?
A. Iron-deficiency anemia
B. Heterozygous alpha-thalassemia A. Plasma hemoglobin level
C. Heterozygous beta-thalassemia B. Serum ferritin level
D. Hemoglobin S/beta-thalassemia C. Hemoglobin electrophoresis
D. Test for parietal cell antibodies
101. What causes the hemolytic process in glucose-6-phosphate
dehydrogenase deficiency following oxidant exposure? 108. Hemoglobinopathies are characterized by
A. Coating of red cells by antibody
A. Absent or reduced rate of globin-chain synthesis
B. Osmotic pressure changes
B. Inability to transport and release oxygen to the tissues
C. Complement attachment

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C. Inhibition of iron chelation needed for heme biosynthesis 117. A cellulose acetate electrophoresis revealed a large band of hemoglobin
D. Production of structurally abnormal hemoglobin variants in the hemoglobin S position. This band quantified at 95%. The peripheral
smear revealed 70% target cells, and the solubility test was negative. Based
on this information, what is the hemoglobin?
109. Which of the following statements about hereditary
A. Hemoglobin C
spherocytosis is true? B. Hemoglobin D
A. Abnormally shaped cells are produced in the bone marrow. C. Hemoglobin E
B. Cells have a decreased mean cell hemoglobin concentration D. Hemoglobin S
(MCHC).
C. Membrane loss and red cell trapping occur in the splenic 118. A previously healthy man experiences weakness and hemoglobinuria
microcirculation. after taking the antimalarial agent primaquine. This hemolytic attack most
likely occurred because of a deficiency of
D. Red cell osmotic fragility is decreased.
A. Pyruvate kinase
B. Glucose-6-phosphate dehydrogenase
110. Which of the following statements about hereditary C. 2,3-Bisphosphoglycerate
elliptocytosis (HE) is true? D. Methemoglobin reductase
A. Characteristic oval shape occurs in mature erythrocytes.
B. Heterogeneous group of disorders linked to Rh-null individuals. 119. Which of the following is an acquired red cell membrane defect that
results in increased sensitivity to complement binding?
C. Cellular defect involves the lipid composition of the membrane.
A. March hemoglobinuria
D. HE cells are abnormally permeable to calcium.
B. Paroxysmal nocturnal hemoglobinuria
C. Paroxysmal cold hemoglobinuria
111. Which of the following disorders is not commonly linked to the D. Methemoglobinemia
development of anemia of chronic disease?
A. Persistent infections 120. Which of the following is not associated with acquired reversible
B. Noninfectious inflammatory disorders sideroblastic anemias?
C. Chronic gastrointestinal blood loss A. Methotrexate therapy
D. Malignancy B. Lead intoxication
C. Isoniazid treatment for tuberculosis
112. Which of the following statements about hemoglobin C disease is false? D. Acute alcohol ingestion
A. Electrophoresis shows approximately 60% hemoglobin A and 40%
hemoglobin C. 121. Which of the following statements about the relative anemia of
B. Target cells are frequently seen on peripheral smears. pregnancy is false?
C. Red cells may contain bar-shaped intracellular crystals. A. It is due to a reduction in the number of erythrocytes.
D. The disorder is less severe than sickle cell disease. B. It is normocytic and normochromic.
C. It does not produce an oxygen deficit for the fetus.
113. Which of the following is associated with sickle cells? D. It is associated with an increase in plasma volume.
A. Increased oxygen tension promotes sickling.
B. There is decreased mechanical fragility. 122. The anemia found in chronic renal failure is most likely caused by
C. There is increased deformability. A. Loss of erythropoietin synthesis
D. Increased sickling occludes vessels. B. Lack of cellular oxygen demand
C. Defective iron absorption
114. A bone marrow M:E ratio of 4:1 would be an expected finding for D. Destruction of red cells by uremic metabolites
A. Sickle cell anemia
B. Aplastic anemia 123. Which of the following phrases about aplastic anemia is false?
C. Beta-thalassemia major A. Stem cell disorder
D. Megaloblastic anemia B. Risk of life-threatening infection
C. Frequent bleeding complications
115. An elderly man with a 10-year history of chronic lymphocytic leukemia D. Reduced red cell survival
presented with jaundice and fatigue that was attributed to a recent 3-gram
drop in his hemoglobin. Many spherocytes and polychromatophilic red cells 124. The fish tapeworm Diphyllobothrium latum is associated with the
were found on his Wright's stained blood smear. Which type of immune development of
hemolytic anemia is most likely? A. Microcytic anemia
A. Idiopathic warm autoimmune hemolytic anemia B. Macrocytic anemia
B. Secondary warm autoimmune hemolytic anemia C. Hemolytic anemia
C. Primary cold hemagglutinin disease D. Hypoproliferative anemia
D. Paroxysmal cold hemoglobinuria
125. An increase in erythropoietin is not a normal compensating mechanism
116. A moderately anemic patient with suspected pernicious anemia (PA) in which of the following conditions?
shows intrinsic factor antibodies and a low cobalamin level. Which of the A. Renal tumors
following would not support the diagnosis of PA? B. Heavy smoking
A. Gastric atrophy and achlorhydria C. Cardiovascular disease
B. Oval macrocytes and Howell-Jolly bodies D. Pulmonary disease
C. Bone marrow erythroid precursors exhibit normoblastic maturation.
D. Elevated serum lactate dehydrogenase (LD) and bilirubin levels 126. Thalassemias are the result of a

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A. Structural defect in the heme portion of hemoglobin A. Consequence of disturbances in calcium metabolism
B. Quantitative defect in globin-chain synthesis B. Result of hyperplastic marrow activity
C. Qualitative defect in globin-chain structure C. Secondary disorder due to immunologic response
D. Change in hemoglobin solubility properties D. Result of increased fibroclast activity

127. Which of the following characterizes iron deficiency anemia? 136. Which of the following does not accurately describe cold autoimmune
A. Decreased serum iron, decreased transferrin saturation, normal ferritin hemolytic anemia?
B. Decreased serum transferrin, decreased transferrin saturation, decreased A. Red cell agglutination in extremities induces Raynaud's phenomenon.
ferritin B. It may occur secondary to Mycoplasma pneumonia.
C. Increased serum transferrin, decreased transferrin saturation, decreased C. Hemolysis is complement-mediated or via removal of coated cells.
ferritin D. The autoantibody is usually an IgG type directed against Rh antigens.
D. Increased serum transferrin, increased transferrin saturation, decreased
serum iron 137. Which of the following represents an anemia that would have a high red
cell distribution width (RDW)?
128. Clinical manifestations of a homozygous mutation involving the beta- A. Sickle cell disease during crisis
globin gene will most likely appear B. Thalassemia minor
A. During embryonic development C. Aplastic anemia
B. In the neonate at birth D. Anemia of chronic disorders
C. No later than 3 weeks after birth
D. By 6 months of age 138. In which of the following disorders would splenomegaly not be a
common finding?
129. The hemolysis associated with infection by malaria organisms is due to A. Homozygous beta-thalassemia
the B. Hereditary spherocytosis
A. Release of merozoites from erythrocytes C. Hemoglobin SC disease
B. Invasion of erythrocytes by merozoites D. Folic acid deficiency
C. Host's immunologic response to infected erythrocytes
D. Toxins produced by the malarial organism
Leukocytes
130. A clinical laboratory scientist received a 5 mL EDTA tube that contained 139. Functionally, white blood cells are divided into
0.5 mL of anticoagulated blood. A smear was prepared and stained with A. Granulocytes, nongranulocytes
Wright's stain. When examined microscopically, the majority of cells B. Polymorphonuclears, mononuclears
appeared to have many evenly distributed, blunt spicules on the surface. C. Phagocytes, immunocytes
How should this cellular appearance be interpreted? D. Granulocytes, lymphocytes
A. An anemic condition requiring further testing
B. Spur cells caused by using incorrect technique during slide preparation 140. What is the largest white blood cell normally found in the peripheral
C. Artifact caused by a dirty spreader slide blood?
D. Crenated cells caused by incorrect blood to anticoagulant ratio A. Eosinophil
B. Neutrophil
131. A failure to generate sufficient ATP is characteristic of red blood cells C. Lymphocyte
with A. Pyruvate kinase deficiency D. Monocyte
B. Glucose-6-phosphate dehydrogenase deficiency
C. Lipoprotein deficiency 141. What is the approximate amount of time a granulocyte spends in the
D. Hexokinase deficiency circulation before migrating into the tissues?
A. Less than 1 day
132. When iron use exceeds absorption, which of the following occurs first? B. About 3 days
A. Hemoglobin level decreases. C. Up to 5 days
B. Iron stores are depleted. D. More than 10 days
C. Transferrin synthesis increases.
D. Excretion of iron decreases. 142. What percentage of neutrophils in the peripheral blood constitutes the
circulating pool?
133. The major mechanism responsible for the anemia of chronic disease is A. 100%
A. Impaired release of storage iron because of increased hepcidin levels B. 80%
B. Damaged bone marrow stem cells C. 50%
C. Immune destruction caused by red cell autoantibodies D. 30%
D. Increased erythropoietin response by committed red cell progenitor cells
143. What is the major phagocytic cell involved in the initial defense against
134. Which of the following is not a characteristic of the idiopathic type of bacterial pathogens?
sideroblastic anemia? A. Neutrophil
A. Refractory to treatment B. Eosinophil
B. Blocks in heme synthesis are unknown C. Basophil
C. Reversible with intramuscular vitamin B12 injections D. Monocyte
D. Subtype of myelodysplastic syndromes
144. What is the growth factor that is primarily responsible for regulating
135. Thinning of bones and deformation of facial bone structure seen in granulocyte and monocyte production?
homozygous beta-thalassemia is a A. Erythropoietin

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B. Colony stimulating factor 154. The most mature granulocyte precursor that can undergo mitosis is the
C. Interleukin A. Myeloblast
D. Thrombopoietin B. Promyelocyte
C. Myelocyte
145. What does the granulocyte mitotic pool in the bone marrow contain? D. Metamyelocyte
A. Myeloblasts and promyelocytes
B. Band and segmented forms 155. Production of primary granules ceases and production of secondary
C. The majority of marrow granulocytes granules commences with what cell stage?
D. Myelocytes and metamyelocytes A. Myeloblast
B. Promyelocyte
146. A "shift to the left," when used to describe a cell population, refers to C. Myelocyte
A. Increased cells in the blood due to a redistribution of blood pools D. Metamyelocyte
B. An increase in immature blood cells following release of bone marrow
pools C. A cell production "hiatus" or gap 156. Which of the following statements about eosinophils is false?
D. A higher percentage of lymphocytes than neutrophils A. They contain a type of peroxidase that is distinct from that of neutrophils.
B. Eosinophilic granules contain lysozyme.
147. Which of the following is characteristic of agranulocytosis? C. Eosinophils are an important line of defense against parasites.
A. Neutrophils without granules D. Major basic protein is a component of eosinophil granules.
B. Decreased numbers of granulocytes, red cells, and platelets
C. Immature granulocytes in the peripheral blood 157. Which of the following is characteristic of primary granules?
D. Decreased numbers of granulocytes A. Coated with a phospholipid membrane
B. Called azurophilic or specific granules
148. Which of the following is not a characteristic of T lymphocytes? C. Contain myeloperoxidase and lactoferrin
A. Secrete cytokines D. Present in the promyelocyte stage only
B. Synthesize antibody
C. Comprise majority of cells in the blood lymphocyte pool 158. Which of the following are indicators of a neutrophilic response to tissue
D. Regulate the immune response damage or inflammatory stimuli?
A. Toxic granules and Dohle bodies in the neutrophils
149. An adult has a total white blood cell count of 4.0 X 10 9/L (4.0 X 103/uL). B. Vacuoles and Barr bodies in the neutrophils
The differential count is as follows: polymorphonuclear neutrophils (PMNs) C. Hypersegmented neutrophils and Auer rods
25%, bands 5%, lymphocytes 65%, and mono cytes 5%. The absolute value D. Pyknotic neutrophils and Russell bodies
reference range for lymphocytes is 1.0—4.0 X 109/L. Which of the following is
true? 159. What is the term for cell movement through blood vessels to a tissue
A. The percentage of lymphocytes is normal. site? A. Diapedesis
B. There is an absolute lymphocytosis. B. Opsonization
C. There is a relative lymphocytosis. C. Margination
D. There is both an absolute and a relative lymphocytosis. D. Chemotaxis

150. Which of the following statements is correct? 160. Vasodilation and bronchoconstriction are the result of degranulation by
A. Hypersegmented neutrophils have four nuclear lobes. which of the following blood cells?
B. Auer rods are composed of fused primary granules. A. Eosinophils
C. Toxic granules are prominent secondary granules. B. Monocytes
D. Dohle bodies are agranular patches of DNA. C. Neutrophils
D. Basophils
151. Which of the following factors is not associated with variations in the
total white blood cell count? 161. On what basis can B and T lymphocytes be distinguished?
A. Age A. Differences in nuclear shape
B. Exercise B. Monoclonal antibody reactions to surface and cytoplasmic antigens
C. Emotional stress C. Cytoplasmic granularity and overall cell size
D. Sex D. Chromatin pattern in the nucleus

152. Of the following, an absolute neutrophil count of 1.0 X 109/L would be 162. Cells that produce immunoglobulins in response to antigenic stimulation
associated with are designated
A. Shortness of breath A. Natural killer cells
B. Bleeding tendencies B. Plasma cells
C. Risk of infection C. Virocytes
D. No clinical symptoms D. Thymocytes

153. Which of the following statements about basophils is false? 163. Which of the following statements about neutrophils is false?
A. Morphologically, basophils resemble tissue mast cells. A. Suppress allergic reactions caused by basophils
B. Membrane receptors bind IgG, initiating anaphylactic reactions. B. Have surface receptors for IgG and complement components
C. Basophilic granules contain heparin and histamine. C. Contain alkaline phosphatase and muramidase
D. Granules are water soluble. D. Act in nonspecific phagocytosis and are destined to die

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164. Which of the following characteristics would be least likely to distinguish 173. Based on the WHO classification system, B cell ALL (FAB type L3) and
reactive lymphocytes from monocytes? represent different clinical presentations of the same disease entity.
A. Sharp indentation of the cytoplasmic margin by adjacent red blood cells A. Burkitt lymphoma
B. Presence of large azurophilic granules B. Hodgkin lymphoma
C. Irregular, indented nuclear shape C. Mycosis fungoides
D. Abundant, deeply basophilic cytoplasm D. Small lymphocytic lymphoma

165. Which of the following can differentiate metamyelocytes from other 174. The presence of both immature neutrophils and nucleated erythrocytes
stages of granulocyte maturation? in the peripheral blood is most accurately called a
A. Presence of specific granules A. Neutrophilic left shift
B. Indentation of nucleus B. Regenerative left shift
C. Absence of nucleoli C. Neutrophilic leukemoid reaction
D. Color of cytoplasm D. Leukoerythroblastic reaction

166. Lymphocyte concentrations in the peripheral blood are greatest during 175. In which anomaly is a failure of granulocytes to divide beyond the band
what age interval? or two lobed stage observed?
A. 1 to 4 years A. Pelger-Huet
B. 4 to 15 years B. May-Hegglin
C. 16 to 40 years C. Alder-Reilly
D. 40 to 70 years D. Chediak-Higashi

167. Which of the following is the least likely to be expressed by early B cell 176. In which of the following are eosinophils not increased?
precursors? A. Gushing syndrome
A. SIgM, a surface membrane immunoglobulin B. Allergic disorders
B. CD34, a hematopoietic stem cell marker C. Skin disorders
C. TdT (terminal deoxynucleotidyl transferase), a nuclear enzyme D. Parasitic infection
D. CD10 (CALLA), a surface antigen
177. Which of the following represents the principal defect in chronic
168. Which of the following statements about macrophages is incorrect? granulomatous disease (CGD)?
A. They are mature tissue forms of blood monocytes. A. Chemotactic migration
B. They serve as antigen-presenting cells to the immune system. B. Phagocytosis
C. Their quantity of lysosomes and acid hydrolases decreases during C. Lysosomal formation and function
maturation. D. Oxidative respiratory burst
D. They remove damaged or dying cells and cellular debris.
178. The blood shown in Color Plate 11 • is from a leukemia patient following
169. Antigen-dependent lymphopoiesis occurs in secondary lymphoid tissue treatment. These findings are most suggestive of therapy with
located in the A. Corticosteroids (e.g., prednisone)
A. Liver and kidney B. A folate antagonist (e.g., methotrexate)
B. Spleen and lymph nodes C. Recombinant erythropoietin
C. Lungs and Peyer's patches D. Chloramphenicol
D. Thymus and bone marrow
179. A patient with normal hemoglobin and WBC count values, a persistently
170. Which of the following is not produced by neutrophils during the elevated platelet count (over 1000 X 10 9/L), increased marrow
respiratory burst? megakaryocytes, and a history of frequent bleeding and clotting episodes
A. Hydroxyl radicals (OH~) most likely has
B. Hydrogen peroxide (H2O2) A. Polycythemia vera
C. Superoxide anion (O^~) B. Chronic myelofibrosis
D. Myeloperoxidase C. Essential thrombocythemia
D. Chronic myelogenous leukemia

Leukocyte Disorders 180. An adult patient with massive splenomegaly has mild anemia, a slightly
171. In patients with infectious mononucleosis, which blood cells are infected elevated WBC count, and an LAP score of 170. The blood smear shows
by the causative agent? teardrop erythrocytes and leukoerythroblastosis. These findings are most
A. Monocytes consistent with
B. T lymphocytes A. Chronic myelogenous leukemia
C. B lymphocytes B. Idiopathic myelofibrosis
D. Histiocytes C. Primary polycythemia
D. Primary thrombocythemia
172. Which of the following statements about hairy cell leukemia is true?
A. It is an acute disease, primarily affecting young adults. 181. Which of the following infections does not reveal a blood picture as seen
B. Splenomegaly is an unusual finding. in Color Plate 12?
C. Hairy cells contain tartrate-resistant acid phosphatase.
D. Hairy cells are abnormal T lymphocytes.

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D. Viral infection

186. In which of the following is progression to acute leukemia least likely?

A. Chronic myelogenous leukemia (CML)
B. Refractory anemia with excess blasts (RAEB)
C. Refractory anemia with ringed sideroblasts (RARS)
D. Chronic lymphocytic leukemia (CLL)

187. A Gaucher cell is best described as a macrophage with

A. "Wrinkled" cytoplasm due to an accumulation of glucocerebroside
A. Epstein-Barr virus (EBV)
B. "Foamy" cytoplasm filled with unmetabolized sphingomyelin
B. Bordetellapertussis (whooping cough)
C. Pronounced vacuolization and deposits of cholesterol
C. Cytomegalovirus (CMV)
D. Abundant cytoplasm containing storage iron and cellular remnants
D. Toxoplasma gondii (toxoplasmosis)
188. Which of the following suggests a diagnosis of Hodgkin disease rather
182. The most common type of chronic lymphocytic leukemia (CLL) in the
than other lymphoproliferative disorders?
United States involves the
A. Presence of a monoclonal population of large lymphoid cells
A. B cell
B. Predominance of immature B cells with irregular nuclear clefts
B. NK cell
C. Circulating T cells with a convoluted, cerebriform nucleus
C. T cell
D. Presence of giant binucleated Reed Sternberg cells with prominent nucleoli
D. Plasma cell
189. In a patient with fever of unknown origin, which of the following findings
183. Which of the following are characteristic findings in Waldenstrom
is not consistent with an inflammatory process?
disease?
A. Increased C-reactive protein
A. Increased IgA and hepatosplenomegaly
B. Increased albumin level
B. Increased IgE and renal failure
C. Increased fibrinogen level
C. Increased IgG and hypercalcemia
D. Increased erythrocyte sedimentation rate
D. Increased IgM and blood hyperviscosity
190. The presence of the chromosomal abnormality t (15;17) and a high
184. Which of the following would not cause a total WBC count of 62.2 X
incidence of disseminated intravascular coagulation (DIG) is diagnostic of
109/L (62.2 X 103/uL) and the blood findings seen in Color Plate 13?
A. Acute myeloblastic leukemia without maturation (FAB type Ml)
B. Acute myeloblastic leukemia with maturation (FAB type M2)
C. Acute promyelocytic leukemia (FAB type M3)
D. Acute myelomonocytic leukemia (FAB type M4)

191. Which of the following is not commonly found in acute myelogenous

leukemias?
A. Neutropenia
B. Thrombocytopenia
C. Hepatosplenomegaly
D. Lymphadenopathy
A. Treatment with myeloid growth factors
B. Gram-negative septicemia 192. The child whose blast cells are shown in Color Plate 15 has acute
C. Human immunodeficiency virus (HIV) lymphoblastic leukemia that is precursor B cell type and CALLA positive.
D. Systemic fungal infection Analysis by flow cytometry would likely show cells that immunophenotype
for
185. The peripheral blood shown in Color Plate 14 is from a 69-year-old
female. Her WBC count was 83.0 X 109 cells/L (83.0 X 103/(uL) and her
platelet count was normal. Based on the cell morphology and this
information, what is the most likely diagnosis?

A. CD2, CD7
B. CD10, CD19
C. CD13, CD33
D. CD14, CD34

A. Acute lymphoblastic leukemia 193. The patient whose bone marrow is shown in Color Plate 16 most likely
B. Chronic lymphocytic leukemia has a(n)
C. Waldenstrom macroglobulinemia

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C. Stains positive with myeloperoxidase (MPO)
D. Identifies the cell as a malignant lymphoblast

200. Which of the following is a typical finding in chronic leukemias at onset?

A. Symptoms of infection and bleeding
B. Significant thrombocytopenia
C. Severe anemia
D. Elevated leukocyte count

201. In what condition would an LAP score of 10 most likely be found?

A. Acute leukemia A. Bacterial septicemia
B. Chronic leukemia B. Late pregnancy
C. Myelodysplastic syndrome C. Polycythemia vera
D. Aplastic anemia D. Chronic myelogenous leukemia

194. Multiple myeloma is characterized by the presence in urine of large 202. Which of the following is not associated with neutrophilia?
amounts of A. Staphylococcal pneumonia
A. Cryoglobulins B. Cm shing injury
B. IgG heavy chains C. Infectious hepatitis
C. IgG light chains D. Neoplasms (tumors)
D. Beta microglobulins
203. In which of the following would an absolute monocytosis not be seen?
195. Which of the following is not classified as a myeloproliferative disorder? A. Tuberculosis
A. Polycythemia vera B. Recovery stage of acute bacterial infection
B. Essential thrombocythemia C. Collagen disorders
C. Multiple myeloma D. Infectious mononucleosis
D. Chronic myelogenous leukemia
204. Coarse PAS positivity may be found in the leukemic cells of
196. Which of the following gene mutations correlates with the t(9;22) that is A. Acute myeloblastic leukemia (FAB type Ml)
present in Philadelphia chromosome positive chronic myelogenous leukemia? B. Acute lymphoblastic leukemia (FAB type LI)
A. MYC/IGH C. Acute myelomonocytic leukemia (FAB type M4)
B. BCR/ABL D. Acute monocytic leukemia (FAB type M5)
C. PML/RARA
D. JAK2 205. Which of the following is not among the diagnostic criteria used for
classifying the myelodysplastic syndromes?
197. Which of the following statements does not correctly describe the WHO A. Unexplained anemia refractory to treatment
(World Health Organization) classification of hematopoietic neoplasms? B. Hypogranular and hyposegmented neutrophils
A. Acute leukemia is defined as the presence of at least 20% bone marrow C. Abnormal platelet size and granulation
blasts. D. Hypocellular bone marrow with 25% blasts
B. Diagnosis is based on cellular morphology and cytochemistry.
C. It groups lymphoid disorders into B cell, T/NK cell, and Hodgkin lymphoma. 206. Naphthol AS-D chloroacetate esterase (specific) is usually positive in
D. Diagnostic criteria include morpho logic, cytochemical, immunologic, cells, and alpha naphthyl acetate esterase (nonspecific) is useful for
cytogenetic, and molecular features. identifying blast cells of lineage.
A. Granulocytic; monocytic
198. Which of the following would be least helpful in distinguishing chronic B. Monocytic; granulocytic
myelogenous leukemia (CML) from a neutrophilic leukemoid reaction? C. Granulocytic; lymphocytic
A. An extreme leukocytosis with increased neutrophilic bands, D. Monocytic; lymphocytic
metamyelocytes, and myelocytes
B. Leukocyte alkaline phosphatase score 207. The familial disorder featuring pseudo Dohle bodies, thrombocytopenia,
C. Presence of marked splenomegaly and large platelets is called
D. Neutrophils with Dohle bodies and toxic granulation A. May-Hegglin anomaly
B. Chediak-Higashi syndrome
199. The cytoplasmic inclusion present in the cell shown in Color Plate 17? C. Pelger-Huet anomaly
D. Alder-Reilly anomaly

208. Alder-Reilly anomaly is an abnormality of

A. Lysosomal fusion
B. Nuclear maturation
C. Oxidative metabolism
D. Mucopolysaccharide metabolism

209. What is the initial laboratory technique for the diagnosis of monoclonal
A. Excludes a diagnosis of acute myelogenous leukemia gammopathies?
B. Stains positive with leukocyte alkaline phosphatase (LAP) A. Immunologic markers of marrow biopsy cells
B. Cytochemical staining of marrow and peripheral blood cells
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C. Serum and urine protein electrophoresis B. Increased red cell mass
D. Cytogenetic analysis of marrow cells C. Increased erythropoietin level
D. Increased blood viscosity
210. Which of the following statements about Hodgkin disease is false?
A. Peak incidence occurs in young adults. 218. In what disorder is significant basophilia most commonly seen?
B. Staging determines extent of disease and treatment course. A. Hairy cell leukemia
C. Stage IV has the best prognosis. B. Plasma cell leukemia
D. Almost a 2:1 male predominance over females is characteristic C. Acute lymphoblastic leukemia
D. Chronic myelogenous leukemia
211. The blast cells shown in Color Plate 18 are CD14 and CD33 positive,
Sudan black B positive, specific esterase positive, and nonspecific esterase 219. Acute erythroleukemia (FAB type M6) is characterized by increased
positive. Which type of acute leukemia is most consistent with the A. Promyelocytes and lysozyme activity
immunophenotyping and cytochemical staining results? B. Marrow megakaryocytes and thrombocytosis
C. Marrow erythroblasts and multinucleated red cells
D. Marrow monoblasts and immature monocytes

220. The blood findings present in Color Plate 20 are from a patient with
complaints of fatigue and severe lower back pain. Which of the following
would not be typical of this disease?

A. Acute lymphoblastic leukemia, T cell type

B. Acute erythroleukemia
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia

212. Which type of leukemia is associated with the best prognosis for a cure?
A. Chronic lymphocytic leukemia in the elderly
B. Acute lymphoblastic leukemia in children
C. Acute myelogenous leukemia in children A. Bone tumors of plasma cells
D. Chronic myelogenous leukemia in young adults B. Hypercalcemia
C. Progressive renal impairment
213. What is the key diagnostic test for Hodgkin lymphoma? D. Normal sedimentation rate
A. Bone marrow biopsy
B. Lymph node biopsy 221. Myeloid metaplasia refers to
C. Spinal tap A. Displacement of normal marrow cells by fibrous tissue
D. Skin biopsy B. Hematopoietic failure
C. Extramedullary hematopoiesis
214. A bone marrow with 90% cellularity and myeloid:erythroid (M:E) ratio of D. Tumors (neoplasms) of the bone marrow
10:1 is most characteristic of
A. Chronic myelogenous leukemia 222. Which of the following statements about non-Hodgkin types of
B. Primary polycythemia lymphoma is true?
C. Beta-thalassemia major A. Lymphadenopathy is the most common presenting symptom.
D. Aplastic anemia B. Initially, they present as a systemic disease rather than a localized tumor.
C. They are often associated with multiple bone lesions.
215. A 60-year-old patient presents with extreme fatigue. Her blood and D. They are characterized by proliferation of malignant cells primarily
bone marrow findings are as follows: severe anemia with a dual RBC involving the bone marrow.
population, 3% marrow blasts, and numerous ringed sideroblasts. This
information is most consistent with
A. Refractory anemia (RA) Methodology
B. Refractory anemia with ringed sideroblasts (RARS) 223. What combination of reagents is used to measure hemoglobin?
C. Refractory anemia with excess blasts (RAEB) A. Hydrochloric acid and p-dimethyl aminobenzaldehyde
D. Chronic myelomonocytic leukemia (CMML) B. Potassium ferricyanide and potassium cyanide
C. Sodium bisulfite and sodium metabisulfite
216. Which of the following is not a mechanism by which neutropenia may D. Sodium citrate and hydrogen peroxide
be produced?
A. Hypersplenism 224. The slowest-moving hemoglobin(s) on an alkaline electrophoresis at pH
B. Marrow injury or replacement 8.6 is(are)
C. Recent strenuous exercise A. A
D. Drug-induced antibodies B. A2, C, E, and O
C. F
217. Which of the following is not a characteristic finding in polycythemia D. S, D, and G
vera?
A. Blood pancytosis

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225. A patient with suspected sickle cell trait has negative solubility test 234. Using the percent reticulocyte from question 233 and an RBC count of
results, but hemoglobin electrophoresis at pH 8.6 shows an apparent A-S 3.00 X 1012/L (3.00 X 106/|xL), the calculated absolute reticulocyte count
pattern. What is the most likely explanation? reported in SI units is
A. Patient has hemoglobin AS, and the solubility test is incorrect. A. 1.8X109/L
B. Patient has hemoglobin AA, and the electrophoresis is incorrect. B. 18X109/L
C. Patient has hemoglobin AD or AG, and both procedures are correct. C. 180X109/L
D. Tests need to be repeated; impossible to determine which procedure is D. 180X103/uL
correct.
235. The Sudan black B stain shown in Color Plate 19 is a stain for
226. Which of the following is an incorrect statement about the solubility test
for Hemoglobin S?
A. Hemoglobin S polymerizes when deoxygenated.
B. Testing performed on a 2-day-old infant can result in a false negative result.
C. Sickle cell trait can be differentiated from sickle cell anemia with this test.
D. The test is positive in hemoglobin CHarlem

227. Which of the following is not associated with causing a falsely low ESR?
A. Column used is slanted.
B. EDTA tube is clotted. A. Glycogen
C. EDTA tube is one-third full. B. Lipids
D. EDTA specimen is 24 hours old. C. Myeloperoxidase
D. Acid phosphatase
228. A platelet count is performed on an automated instrument from an
EDTA blood sample. Smear evaluation reveals the presence of platelet 236. The following numbers were obtained in evaluating leukocyte alkaline
clumps. The specimen is redrawn using sodium citrate as the anticoagulant, phosphatase (LAP) activity in neutrophils. What is the score?
and a count of 300 X 109/L is obtained. What is the correct platelet count to 0 1 2 3 4
report? 15 20 30 20 15
A. 270X109/L A. 100
B. 300X109/L B. 115
C. 330X109/L C. 200
D. 360X109/L D. 215

229. To best preserve cellular morphology, differential smears from an EDTA 237. Perl's Prussian blue is a stain used to detect
specimen should be made no more than hour(s) after collection. A. DNA
A. 1 B. RNA
B. 5 C. Iron
C. 12 D. Glycogen
D. 24
238. Which of the following red cell inclusions stain with both Perl's Prussian
230. The blood smear made on a patient with polycythemia vera is too short. blue and Wright's stain?
What should be done to correct this problem? A. Howell-Jolly bodies
A. Decrease the angle of the spreader slide. B. Basophilic stippling
B. Increase the angle of the spreader slide. C. Pappenheimer bodies
C. Adjust the angle of the spreader slide to 45 degrees. D. Heinz bodies
D. Use a smaller drop of blood.
239. What is the depth between the counting platform and the coverslip on a
231. The components of Wright's stain include hemacytometer?
A. Crystal violet and safranin A. 0.01mm
B. Brilliant green and neutral red B. 0.10mm
C. New methylene blue and carbolfuchsin C. 1.00mm
D. Methylene blue and eosin D. 0.1 cm

232. What is the reason for red blood cells to be bright red and the WBC 240. A WBC count is performed on a hemacytometer using a 1:20 dilution.
nuclei to be poorly stained when using Wright's stain? 308 cells are seen in a total area of 8 mm2. What is the WBC count?
A. The staining time is too long. A. 3.8X109/L
B. The stain or buffer is too alkaline. B. 7.7X109/L
C. The stain or buffer is too acidic. C. 15.4X109/L
D. The smear was not washed long enough. D. 38.5X109/L

233. If 60 reticulocytes are counted in 1000 red blood cells, what is the 241. Which set of results indicates that an error in measurement has
reticulocyte count? occurred?
A. 0.06% RBCx1012/L Hgb (g/dL) Hct (%)
B. 0.6%
A 2.50 7.6 22.9
C. 6.0%
B 2.75 9.5 24.8
D. 60.0% C 3.40 10.0 31.0
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242. Which of the following would not be the cause of a falsely high MCHC of A. Reference interval
38.3 g/dL on an automated instrument? B. Linearity limit
A. Hereditary spherocytosis C. Reportable range
B. Lipemia D. Critical range
C. Presence of a cold agglutinin
D. Instrument sampling or mixing error 251. To establish a standard curve for reading hemoglobin concentration,
A. A commercial control material is used.
243. What is the principle of automated impedance cell counters? B. A wavelength of 640 nm is employed.
A. Angle of laser beam scatter by cells C. Certified standards are used.
B. Amplification of an electrical current by cells D. A patient blood sample of known hemoglobin concentration is used.
C. Interruption of an electrical current by cells
D. Change in optical density of the solution containing cells 252. Which of the following is not a source of error when measuring
hemoglobin by the cyanmethemoglobin method?
244. A clinically significant difference between two electronic cell counts is A. Excessive anticoagulant
indicated when the standard deviation is greater than B. White blood cell count that exceeds linearity limits
A. ±1.0 C. Lipemic plasma
B. ±1.5 D. Scratched or dirty hemoglobin measuring cell
C. ±2.0
D. ±3.0 253. Which of the following statements about microhematocrits is false?
A. Excessive centrifugation causes falsely low results.
245. Side angle scatter in a laser-based cell counting system is used to B. A tube less than half full causes falsely low results.
measure A. Cell size C. Hemolysis causes falsely low results.
B. Cytoplasmic granularity D. Trapped plasma causes falsely high results.
C. Cell number
D. Immunologic (antigenic) identification 254. The erythrocyte sedimentation rate (ESR) is influenced by the red cell
phenomenon seen in Color Plate 20. Which of the following factors will
246. A white blood cell count is done on an automated impedance cell neither contribute to this phenomenon nor affect the ESR?
counter from a patient with the blood picture seen in Color Plate 4. The WBC A. Size of the red blood cells
count is most likely B. Shape of the red blood cells
C. Hemoglobin content of the red blood cells
D. Composition of the plasma

255. An EDTA blood sample run on an automated impedance cell counter has
generated a warning flag at the upper region of the platelet histogram
illustrated below. Which of the following would not be a cause of this
warning flag?

A. Falsely increased because of nRBCs

B. Falsely increased because of red cell fragments
C. Falsely decreased because of nRBCs
D. Accurate; no error with this methodology

247. The hemoglobin A2 quantification using anion exchange

chromatography will be valid in
A. Hemoglobin C disease
B. Hemoglobin E trait
C. Hemoglobin O trait A. Nucleated RBCs
D. Beta-thalassemia minor B. Microcytic RBCs
C. EDTA-dependent platelet agglutinins
248. Which of the following is not associated with an increased osmotic D. Giant platelets
fragility and a decreased surface area-to-volume ratio?
A. Beta-thalassemia major 256. To evaluate normal platelet numbers in an appropriate area of a blood
B. Hereditary spherocytosis smear, approximately how many platelets should be observed per oil
C. Warm autoimmune hemolytic anemia immersion field?
D. Burn victims A. 1-4
B. 4-10
249. A clotted EDTA tube can be used to perform a(n) C. 8-20
A. Erythrocyte sedimentation rate D. 20-50
B. Solubility test for hemoglobin S
C. Hematocrit 257. Which of the following statements about manual reticulocyte counts is
D. Platelet count false?
A. The blood/stain mixture is incubated for 5-10 minutes.
250. The test value range that includes 95% of the normal population is the B. New methylene blue, a supravital stain, is used.

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C. RBC inclusions can result in falsely elevated counts. The peripheral blood shown in Color Plate 4 is from a 10-month-old Greek
D. An erythrocyte must have at least 4 blue particles to be counted as a boy with the following results on an automated impedance counter:
reticulocyte. WBC 35.0 X 109/L (35.0 X 103/(uL)
RBC 2.50 x 1012/L (2.50 x 106/uL)
258. When are automated cell counters required to have a calibration check Hemoglobin 45 g/L (4.5 g/dL)
performed? Hematocrit 0.16 L7L (16%)
A. At least every 3 months Platelet count 250 X 109/L (250,000/uL)
B. After replacement of any major part Reticulocyte count 8.0%; 110 nucleated red blood cells/100 WBCs
C. After performing monthly maintenance and many targets are seen.
D. When the control values are greater than 2 standard deviations from the Other laboratory results are as follows:
mean serum iron elevated
total iron-binding capacity (TIBC) decreased
259. A blood sample was run through an automated cell counter and the serum ferritin elevated
following results were obtained:
WBC 6.9 X 109/L (6.9 X 103/(uL) 264. What is the corrected white blood cell count expressed in SI units of
RBC 3.52 X 1012/L (3.52 X 106/uL) X109/L?
Hgb 120 g/L (12.0 g/dL) A. 4.6
Hct 0.32 L/L (32.0%) B. 12.5
MCH 34.1 pg C. 16.7
MCHC 37.5 g/dL D. 18.4
Which of the troubleshooting steps that follows should be performed to
obtain reportable results? 265. What would be the appearance of the child's red blood cells on a
A. Perform a saline replacement procedure. peripheral smear?
B. Warm the specimen to 37°C and rerun. A. Microcytic, hypochromic
C. Perform a microhematocrit. B. Normocytic, hypochromic
D. None; the results are reportable. C. Normocytic, normochromic
D. Microcytic, normochromic
260. Which of the following tests could be performed on a hemolyzed blood
sample? 266. The CBC, serum iron, total iron-binding capacity, and serum ferritin
A. Hemoglobin only levels are most characteristic of
B. Hemoglobin and platelet count A. Beta-thalassemia minor
C. RBC count and hematocrit B. Iron-deficiency anemia
D. No results would be reportable. C. Alpha-thalassemia minor
D. Beta-thalassemia major
261. For which of the following procedures would heparin be a
recommended anticoagulant? 267. What type(s) of hemoglobin will be detected on this child using
A. Platelet count hemoglobin electrophoresis?
B. Coagulation tests A. A only
C. Smear-based red cell morphology B. A and F
D. Osmotic fragility C. A, increased A2, F
D. F only
262. In the platelet count procedure using phase microscopy,
A. Platelets appear dark against a light background. 268. Why is it difficult to diagnose this disorder in a newborn?
B. The entire ruled counting surface of the hemacytometer is used. A. The liver is immature.
C. Ammonium oxalate will lyse the WBCs. B. The beta chains are not fully developed at birth.
D. Platelets should be counted immediately after plating the hemacytometer. C. It is similar to hemolytic disease of the newborn (HDN) because of ABO
incompatibility.
263. What is the quality control term used to describe the reproducibility of a D. There are normally many erythrocyte precursors in the peripheral blood.
test?
A. Accuracy Use the following information to answer questions 269-271.
B. Precision
C. Standard deviation A 75-year-old man with rheumatoid arthritis complains to his physician of
D. Specificity pain and fatigue. His CBC results are as follows:
WBC 6.8 x 109/L (6.8 X 103/uL)
RBC 3.49 x 1012/L (3.49 x 106/uL)
Case Histories Hemoglobin 97 g/L (9.7 g/dL)
Use the following information to answer questions 264-268. Hematocrit 0.29 L/L (29%)
MCV 83 fl
MCHC 33.9 g/dL.
Other laboratory results are as follows:
serum iron and total iron-binding capacity (TIBC) ↓
serum ferritin slightly ↑

269. If the serum iron is 22 ug/dL and the TIBC is 150 ug/dL, what is the
percent transferrin?
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A. 7% 273. In the absence of neurological symptoms, the anemia in this patient is
B. 10% most likely caused by a lack of
C. 12% A. An enzyme
D. 15% B. Iron
C. Folic acid
270. The results of the CBC and iron studies in this case are most D. Intrinsic factor
characteristic of
A. Beta-thalassemia minor 274. Which of the following is not a laboratory finding in this general
B. Iron deficiency classification of anemia?
C. Sideroblastic anemia A. Target cells and schistocytes
D. Anemia of chronic disease B. Teardrop cells and macro-ovalocytes
C. Howell-Jolly bodies and Cabot rings
271. Which of the following is not associated with the anemia described in D. Elevated serum LD and iron levels
question 270?
A. Chronic gastrointestinal blood loss Use the following information to answer questions 275-277.
B. Hodgkin lymphoma
C. Tuberculosis A 45-year-old Scandinavian woman with white hair appears older than her
D. Systemic lupus erythematosus age. She complains to her physician of weakness, a tingling sensation in her
lower extremities, and shortness of breath. Her CBC results are as follows:
Use the following information to answer questions 272-274. WBC 3.4 x 109/L (3.4 x 103/uL)\
RBC 1.90 x 1012/L (1.90 x 106/uL)
The peripheral blood shown in Color Plate 11 is from a 19-year-old female Hemoglobin level 86 g/L (8.6 g/dL)
college student who has been living primarily on tea, beer, and cereal for the Hematocrit 0.25 L/L (25%)
past 9 months because she finds dining hall food distasteful. She visits MCV 132 fl
student health complaining of fatigue. Her CBC results are as follows: MCHC 34.4 g/dL
WBC 2.5 X 109/L (2.5 X 103/uL) Platelet count 100 x 109/L (100,000/uL).
RBC 2.10 X 1012/L (2.10 x 106/uL) Cabot rings are noted on the peripheral smear.
Hemoglobin 85 g/L (8.5 g/dL)
Hematocrit 0.24 L/L (24%) 275. The clinical and laboratory findings are most consistent with
Platelet count 110x109/L (110,000/uL) A. Liver disease
MCV 114 fL B. Pernicious anemia
MCHC 35.0 g/dL C. Folic acid deficiency
Reticulocyte count 0.8%. D. Aplastic anemia

276. Which of the following is not associated with this disorder?

A. Alcoholism
B. Antibodies to intrinsic factor or parietal cells
C. Diphyllobothrium latum infection
D. Achlorhydria

277. Which of the following statements about megaloblastic anemia is true?

A. Oral folate therapy reverses the neurologic symptoms of PA.
B. Intramuscular injections of vitamin B12 will reverse the neurologic
symptoms of PA.
Use the following information to answer questions 272-274. C. Methotrexate (chemotherapeutic agent) is a vitamin B12 antagonist.
D. Folate deficiency takes years to develop.
The peripheral blood shown in Color Plate 11 is from a 19-year-old female
college student who has been living primarily on tea, beer, and cereal for the Use the following information to answer questions 278-280.
past 9 months because she finds dining hall food distasteful. She visits A 32-year-old African-American traveling to Africa on business had been
student health complaining of fatigue. Her CBC results are as follows: healthy until he began taking primaquine for prevention of malaria. He went
WBC 2.5 X 109/L (2.5 X 103/uL) to his physician because he felt faint and his urine was black. His CBC results
RBC 2.10 X 1012/L (2.10 x 106/uL) are as follows:
Hemoglobin 85 g/L (8.5 g/dL) WBC 6.5 X 109/L (6.5 X 103/uL)
Hematocrit 0.24 L/L (24%) RBC 1.67 X 1012/L (1.67x106/uL)
Platelet count 110x109/L (110,000/uL) Hemoglobin level 50 g/L (5.0 g/dL)
MCV 114 fL Hematocrit 0.15 L7L (15%)
MCHC 35.0 g/dL MCV 89.8 fL
Reticulocyte count 0.8%. MCHC 33.3 g/dL
Platelet count 175 x 109/L (175,000/uL)
272. What test(s) should be done first to determine a diagnosis in this Reticulocyte 25.0%.
patient? A. Vitamin B12 and Mate levels
B. Iron studies 278. The most likely cause of this hemolytic episode is
C. Bone marrow examination A. G6PD deficiency
D. Osmotic fragility B. Hereditary spherocytosis

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C. Sickle cell disease C. 200X109/L
D. Pyruvate kinase deficiency D. 400X109/L

279. The defect in this disorder is caused by an 285. What is this child's most probable diagnosis?
A. Amino acid substitution A. Acute lymphoblastic leukemia
B. Intrinsic red blood cell membrane defect B. Acute myelogenous leukemia
C. Enzyme deficiency in the hexose monophosphate shunt C. Hairy cell leukemia
D. Enzyme deficiency in the Embden-Meyerhof pathway D. Myelodysplastic syndrome

280. Inclusions that form when the patient is oxidatively challenged are 286. Which of the following cytochemical stains would most likely be positive
composed of in the blast cells of this patient?
A. RNA A. Myeloperoxidase
B. Denatured hemoglobin B. Leukocyte alkaline phosphatase
C. DNA C. Periodic acid-Schiff
D. Iron D. Nonspecific esterase

Use the following information to answer questions 281-283. 287. Terminal deoxyribonucleotidyl transferase (TdT) is present in
A. Precursor B and precursor T lymphoid cells
A 15-month-old malnourished child is brought to the clinic for a routine B. Mature B and T lymphocytes
examination. Her CBC results are as follows: C. Precursor B cells and mature B lymphocytes
WBC 9.5 x 109/L (9.5 x 103/uL) D. Precursor T cells and mature T lymphocytes
RBC 2.70 X 1012/L (2.70 X 106/uL)
Hemoglobin 67 g/L (6.7 g/dL) 288. The presence of CD2, CD5, CD7 and the absence of CD10 (CALLA) are
Hematocrit 0.25 L/L (25%) associated with
MCV 73.5 fl_ A. B lymphocytes
MCHC 26.8 g/dL B. T lymphocytes
Reticulocyte 0.2%; ROW 19%. C. Myeloid cells
Abnormal RBC morphology present included pencil forms and target D. Monocytic cells
cells.
Use the following information to answer questions 289-292.
281. What is this toddler's most probable diagnosis?
A. Folic acid deficiency
B. Hereditary spherocytosis
C. Iron deficiency
D. Erythroblastosis fetalis

282. The earliest indicator of this disease state is

A. Decreased folic acid
B. Decreased serum iron
C. Decreased serum ferritin The peripheral blood smear in Color Plate 17 and the Sudan black B stain in
D. Increased bilirubin Color Plate 19 are from a 90-year-old man complaining of fatigue and
nosebleeds. The physician noted the patient was febrile and had petechiae.
283. What is the toddler's absolute reticulocyte count? CBC results were as follows:
A. 0.05X109/L WBC 20.0 x 109/L (20.0 x 103/uL)
B. 0.5X109/L RBC 2.58 x 1012/L (2.58 x 106/uL)
C. 5X109/L Hemoglobin 77 g/L (7.7 g/dL)
D. 50X109/L Hematocrit 0.24 L7L (24%)
Platelet count 32 x 109/L (32,000/uL)
Use the following information to answer questions 284-288 Differential count shows:
75% blasts
An 8-year-old girl is seen by the family physician. On physical examination, 20% lymphocytes
the physician notes fever, sore throat, bruising, petechiae, and pallor. A CBC is 5% segmented neutrophils
drawn and the results are as follows: A bone marrow examination revealed 80% cellularity with 80% blasts. The
WBC 110x109/L (110X103/uL) blasts were myeloperoxidase and specific esterase positive; nonspecific
RBC 1.70 x 1012/L (1.70 x 106/uL) esterase and PAS negative.
Hemoglobin 55 g/L (5.5 g/dL)
Hematocrit 0.16 L/L (16%) 289. What is this patient's most likely diagnosis?
Differential count shows 93% blasts and 7% lymphocytes. A. Acute myelogenous leukemia without maturation (FAB type Ml)
A bone marrow examination is performed and reveals 85% blasts. All of the B. Acute myelogenous leukemia with maturation (FAB type M2)
blasts are small with no variation in their appearance. C. Acute monocytic leukemia (FAB type M5)
D. Myelodysplastic syndrome
284. Which of the following would you expect to most accurately reflect the
child's platelet count? 290. Cytogenetic studies would most likely show which of the following
A. 10X109/L chromosome abnormalities?
B. 100X109/L A. t (8;21)

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B. t (8;14) A. MDS is "preleukemic" and frequently terminates in acute leukemia.
C. t (9;22) B. Treatment for MDS is only supportive and not a cure.
D. t (15;17) C. Median survival for all types of MDS is 5 years.
D. The lower the blast percent, the longer is the survival rate.
291. Using World Health Organization (WHO) criteria for the diagnosis of
acute leukemia, the percentage of bone marrow blasts must be at least Use the following information to answer questions 297-300
A. 5
B. 20 A 53-year-old man reported to the laboratory for routine blood work as part
C. 30 of a yearly physical. He had been feeling tired for the last few months.
D. 50 Physical examination revealed splenomegaly. His CBC results are as follows:
WBC 80.0 x 109/L (80.0 X 103/uL)
292. Which of the following is not considered an underlying condition that RBC 4.10x1012/L (4.10 X 106/uL)
predisposes a patient to acute leukemia? Hemoglobin 123 g/L (12.3 g/dL)
A. Viral infections Hematocrit 0.37 L7L (37.0%)
B. Bacterial infections Platelet count 650 x 109/L (650,000/uL)
C. Chronic bone marrow dysfunction Differential count shows
D. Congenital chromosome abnormalities 40% polymorphonuclear neutrophils
18% bands
Use the following information to answer questions 293-296 5% metamyelocytes
7% myelocyte
An 83-year-old woman is seen in the emergency department complaining of 28% lymphocytes
fatigue and recent weight loss. Her CBC results are as follows: 2% monocytes
WBC 2.6 X 109/L (2.6 X 103/uL) No RBC or WBC morphologic abnormalities are seen.
RBC 2.79 X 1012/L (2.79 x 106/uL)
Hemoglobin 92 g/L (9.2 g/dL) 297. The peripheral blood findings are most consistent with a diagnosis of
Hematocrit 0.28 L/L (28%) A. Neutrophilic leukemoid reaction
MCV 100.0 fl B. Chronic myelogenous leukemia
ROW 23.5% C. Acute myelogenous leukemia
Platelet count 42 x 109/L (42,000/uL) D. Regenerative left shift
Differential count shows:
42% segmented neutrophils 298. Which of the following would yield the most diagnostic information for
45% band neutrophils this patient?
3% lymphocytes A. Sudan black B (SBB)
3% metamyelocytes B. Periodic acid-Schiff (PAS)
4% myelocytes C. Tartrate-resistant acid phosphatase (TRAP)
3% blasts D. Leukocyte alkaline phosphatase (LAP)
4 nRBC/100 WBC.
Morphologic changes noted on the differential smear include poor 299. Which of the following myeloproliferative disorders is characterized by
granulation and hyposegmentation of the neutrophils, giant platelets that the presence of a t (9;22) chromosome abnormality and the BCR/ABL
display poor granulation, oval macrocytes, basophilic stippling, Cabot rings, oncogene?
Pappenheimer bodies, and Howell-Jolly bodies. Three micromegakaryocytes A. Polycythemia vera
are seen per 100 WBCs. Serum B12 and folate levels are normal. B. Essential thrombocythemia
C. Chronic myelogenous leukemia
293. The peripheral blood findings are most consistent with D. Chronic idiopathic myelofibrosis
A. Myelodysplastic syndrome
B. Degenerative left shift 300. How does the presence of this chromo some abnormality affect the
C. Megaloblastic anemia prognosis?
D. Chronic myelogenous leukemia A. It is not a prognostic indicator.
B. The prognosis is better when the abnormality is present.
294. The expected bone marrow findings in this disorder using WHO criteria C. The prognosis is better when the abnormality is not present.
are D. Progression to acute lymphoblastic leukemia occurs more often when the
A. Hypocellular; blasts ≥ 20% abnormality is present.
B. Hypocellular; blasts 20%
C. Hypercellular; blasts ≥ 20%
D. Hypercellular; blasts < 20%

295. If the bone marrow in this patient had 18% blasts, the most likely
disorder would be
A. Chronic myelomonocytic leukemia (CMML)
B. Chronic myelogenous leukemia (CML)
C. Refractory anemia with ringed sideroblasts (RARS)
D. Refractory anemia with excess blasts (RAEB)

296. Which of the following is a false statement about myelodysplastic

syndromes?

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