HEMATOLOGY

1. Insufficient centrifugation will result in:

A. A false increase in hematocrit (Hct) value B. A false decrease in Hct value
C. No effect on Hct value
D. All of these options, depending on the patient
2. Variation in red blood cell (RBC) size observed on the peripheral blood smear is described
as:
A. Anisocytosis
B. Hypochromia
C. Poikilocytosis
D. Pleocytosis
3. Which of the following is the preferred site for bone marrow aspiration and biopsy in an adult?
A. Iliac crest
B. Sternum
C. Tibia
D. Spinous processes of a vertebra
4. Mean cell volume (MCV) is calculated by using the following formula:
A. (Hgb ÷ RBC) × 10 where Hgb is hemoglobin in g/dL
B. (Hct ÷ RBC) × 10
C. (Hct ÷ Hgb) × 100
D. (Hgb ÷ RBC) × 100
5. What term describes the change in shape of erythrocytes seen on a Wright-stained peripheral
blood smear?
A. Poikilocytosis
B. Anisocytosis
C. Hypochromia
D. Polychromasia
6. Calculate the mean cell hemoglobin concentration (MCHC) by using the following values:
Hgb: 15 g/dL (150 g/L)
RBC: 4.50 × 106/μL (4.50 × 1012/L)
A. 9.5% (0.095)
B. 10.4% (0.104)
C. 31.9% (0.319)
D. 33.3% (0.333)
7. A manual white blood cell (WBC) count was performed. In total 36 cells were counted in all 9-
mm2 squares of a Neubauer-ruled hemacytometer. A 1:10 dilution was used. What is the WBC
count?
A. 0.4 × 109/L
B. 2.5 × 109/L
C. 4.0 × 109/L
D. 8.0 × 109/L
8. When an erythrocyte containing iron granules is stained with Prussian blue, the cell is called
a:
A. Spherocyte
B. Leptocyte
C. Schistocyte
D. Siderocyte
9. A 7.0-mL ethylenediaminetetraacetic acid (EDTA) tube is received in the laboratory
containing only 2.0 mL of blood. If the laboratory is using manual techniques, which of the
following tests will most likely be erroneous?
A. RBC count
B. Hgb
C. Hct
D. WBC count
10. A 1:200 dilution of a patient’s sample was made, and 336 RBCs were counted in an area of
0.2 mm2. What is the RBC count?
A. 1.68 × 1012/L
B. 3.36 × 1012/L
C. 4.47 × 1012/L
D. 6.66 × 1012/L
11. What phagocytic cells produce lysozymes that are bactericidal?
A. Eosinophils
B. Lymphocytes
C. Platelets (PLTs)
D. Neutrophils
12. If a patient has a reticulocyte count of 7% and Hct of 20%, what is the corrected reticulocyte
count?
A. 1.4%
B. 3.1%
C. 3.5%
D. 14%
13. A decreased osmotic fragility test would be associated with which of the following
conditions?
A. Sickle cell anemia
B. Hereditary spherocytosis (HS)
C. Hemolytic disease of the fetus and newborn
D. Acquired hemolytic anemia
14. What effect would using a buffer at pH 6.0 have on a Wright-stained smear?
A. RBCs would be stained too pink
B. WBC cytoplasm would be stained too blue
C. RBCs would be stained too blue
D. RBCs would lyse on the slide
15. Which of the following erythrocyte inclusions can be visualized with supravital stain but
cannot be detected on a Wright-stained blood smear?
A. Basophilic stippling
B. Heinz bodies
C. Howell–Jolly bodies
D. Siderotic granules
16. A falsely elevated Hct is obtained. Which of the following calculated values will not be
affected?
A. MCV
B. Mean corpuscular hemoglobin (MCH)
C. MCHC
D. Red blood cell distribution width (RDW)
17. A Miller disk is an ocular device used to facilitate counting of:
A. PLT
B. Reticulocytes
C. Sickle cells
D. Nucleated red blood cells (NRBCs)
18. SITUATION: RBC indices obtained on an anemic patient are as follows: MCV 88 μm3 (fL);
MCH 30 pg; MCHC 34% (0.340). The RBCs on the peripheral blood smear would appear:
A. Microcytic, hypochromic
B. Microcytic, normochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic
19. All of the following factors may influence the erythrocyte sedimentation rate (ESR) except:
A. Blood drawn into a sodium citrate tube
B. Anisocytosis, poikilocytosis
C. Plasma proteins
D. Caliber of the tube
20. What staining method is used most frequently to stain and manually count reticulocytes?
A. Immunofluorescence
B. Supravital staining
C. Romanowsky staining
D. Cytochemical staining
21. The Coulter principle for counting of cells is based on the fact that:
A. Isotonic solutions conduct electricity better than cells do
B. Conductivity varies proportionally to the number of cells
C. Cells conduct electricity better than saline does
D. Isotonic solutions cannot conduct electricity
22. A correction is necessary for WBC counts when NRBCs are seen on the peripheral blood
smear because:
A. The WBC count would be falsely lower
B. The RBC count is too low
C. NRBCs are counted as leukocytes
D. NRBCs are confused with giant PLTs
23. Using an electronic cell counter analyzer, an increased RDW should correlate with:
A. Spherocytosis
B. Anisocytosis
C. Leukocytosis
D. Presence of NRBCs
24. Given the following values, which set of RBC indices suggests spherocytosis?
A. MCV 76 μm3 MCH 19.9 pg MCHC 28.5%
B. MCV 90 μm3 MCH 30.5 pg MCHC 32.5%
C. MCV 80 μm3 MCH 36.5 pg MCHC 39.0%
D. MCV 81 μm3 MCH 29.0 pg MCHC 34.8%
25. Which of the following statistical terms reflects the best index of precision when comparing
two complete blood count (CBC) parameters?
A. Mean
B. Median
C. Coefficient of variation
D. Standard deviation
26. Which of the following is considered a normal Hgb?
A. Carboxyhemoglobin
B. Methemoglobin
C. Sulfhemoglobin
D. Deoxyhemoglobin
27. Which condition will shift the oxyhemoglobin dissociation curve to the right?
A. Acidosis
B. Alkalosis
C. Multiple blood transfusions
D. Increased quantities of Hgb S or C
28. What is the major type of leukocyte seen in the peripheral blood smear from a patient with
aplastic anemia?
A. Segmented neutrophil
B. Lymphocyte
C. Monocyte
D. Eosinophil
29. What is the normal WBC differential lymphocyte percentage (range) in the adult population?
A. 5%–10%
B. 10%–20%
C. 20%–44%
D. 50%–70%
30. In which age group would 60% lymphocytes be a normal finding?
A. 6 months–2 years
B. 4–6 years
C. 11–15 years
D. 40–60 years
31. Which of the following results on an automated differential suggests that a peripheral blood
smear should be reviewed manually?
A. Segs = 70%
B. Band = 6%
C. Mono = 15%
D. Eos = 2%
32. Which is the first stage of erythrocytic maturation in which the cytoplasm is pink because of
the formation of Hgb?
A. Reticulocyte
B. Pronormoblast
C. Basophilic normoblast
D. Polychromatic normoblast
33. Which of the following can shift the Hgb oxygen (O2) dissociation curve to the right?
A. Increases in 2,3 DPG
B. Acidosis
C. Hypoxia
D. All of these options
34. Which of the following Hgb configurations is characteristic of Hgb H? A. γ4
B. α2-γ2
C. β4
D. α2-β2
35. Autoagglutination of RBCs at room temperature can cause which of the following abnormal
test results?
A. Low RBC count
B. High MCV
C. Low Hct
D. All of these options

1.2
1. Hypersplenism is characterized by: A. Polycythemia
B. Pancytosis
C. Leukopenia
D. Myelodysplasia
2. Which of the following organs is responsible for the “pitting process” in RBCs? A. Liver
B. Spleen
C. Kidney
D. Lymph nodes
3. Spherocytes differ from normal RBCs in all of the following except: A. Decreased surface to
volume
B. No central pallor
C. Decreased resistance to hypotonic saline
D. Increased deformability
4. Which of the following is not associated with HS? A. Increased osmotic fragility
B. MCHC greater than 36%
C. Intravascular hemolysis
D. Extravascular hemolysis
5. Which of the following disorders has an increase in osmotic fragility? A. Iron deficiency
anemia (IDA)
B. Hereditary elliptocytosis (HE)
C. Hereditary stomatocytosis
D. Hereditary spherocytosis (HS)
6. The anemia seen in sickle cell disease is usually: A. Microcytic, normochromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Normocytic, hypochromic
7. Which is the major Hgb found in the RBCs of patients with the sickle cell trait? A. Hgb S
B. Hgb F
C. Hgb A2
D. Hgb A
8. Select the amino acid substitution that is responsible for sickle cell anemia. A. Lysine is
substituted for glutamic acid at the sixth position of the α-chain
B. Valine is substituted for glutamic acid at the sixth position of the β-chain
C. Valine is substituted for glutamic acid at the sixth position of the α-chain
D. Glutamine is substituted for glutamic acid at the sixth position of the β-chain
9. All of the following are usually found in Hgb C disease except:
A. Hgb C crystals
B. Target cells
C. Lysine substituted for glutamic acid at the sixth position of the β–chain
D. Fast mobility of Hgb C at pH 8.6
10. Which of the following Hgbs migrates to the same position as Hgb A2 at pH 8.6?
A. Hgb H
B. Hgb F
C. Hgb C
D. Hgb S
11. Which of the following electrophoretic results is consistent with a diagnosis of the sickle cell
trait?
A.HgbA:40% HgbS:35% HgbF:5%
B.HgbA:60% HgbS:40% HgbA2:2%
C.HgbA:0% HgbA2:5% HgbF:95%
D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%
12. In which of the following conditions will autosplenectomy most likely occur? A. Thalassemia
major
B. Hgb C disease
C. Hgb SC disease
D. Sickle cell disease
13. Which of the following is most true of paroxysmal nocturnal hemoglobinuria (PNH)? A. It is a
rare acquired stem cell disorder that results in hemolysis
B. It is inherited as a sex-linked trait
C. It is inherited as an autosomal dominant trait
D. It is inherited as an autosomal recessive trait
14. Hemolytic uremic syndrome (HUS) is characterized by all of the following except: A.
Hemorrhage
B. Thrombocytopenia
C. Hemoglobinuria
D. Reticulocytopenia
15. The autohemolysis test result is positive in all of the following conditions except: A. Glucose-
6-phosphate dehydrogenase (G6PD) deficiency
B. HS
C. Pyruvate kinase (PK) deficiency
D. PNH
16. Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
A. Anti-I
B. Anti-i
C. Anti-M
D. Anti-P
17. All of the following are associated with intravascular hemolysis except: A.
Methemoglobinemia
B. Hemoglobinuria
C. Hemoglobinemia
D. Decreased haptoglobin
18. Autoimmune hemolytic anemia (AIHA) is best characterized by which of the following?
A. Increased levels of plasma C3
B. Spherocytic RBCs
C. Decreased osmotic fragility
D. Decreased unconjugated bilirubin
19. “Bite cells” are usually seen in patients with:
A. Rh null trait
B. Chronic granulomatous disease
C. G6PD deficiency
D. PK deficiency
20. The morphological classification of anemias is based on which of the following? A.
Myeloid:erythroid (M:E) ratio
B. Prussian blue stain
C. RBC indices
D. Reticulocyte count
21. Which of the following is a common finding in aplastic anemia?
A. A monoclonal disorder
B. Tumor infiltration
C. Peripheral blood pancytopenia
D. Defective deoxyribonucleic acid (DNA) synthesis
22. Congenital dyserythropoietic anemias (CDAs) are characterized by:
A. Bizarre multinucleated erythroblasts
B. Cytogenetic disorders
C. Megaloblastic erythropoiesis
D. An elevated M:E ratio
23. Microangiopathic hemolytic anemia is characterized by:
A. Target cells and Cabot rings
B. Toxic granulation and Döhle bodies
C. Pappenheimer bodies and basophilic stippling
D. Schistocytes and NRBCs
24. Which antibiotic(s) is (are) most often implicated in the development of aplastic anemia?
A. Sulfonamides
B. Penicillin
C. Tetracycline
D. Chloramphenicol
25. Sickle cell disorders are:
A. Hereditary, intracorpuscular RBC defects
B. Hereditary, extracorpuscular RBC defects
C. Acquired, intracorpuscular RBC defects
D. Acquired, extracorpuscular RBC defects
26. Which of the following conditions may produce spherocytes in a peripheral blood smear?
A. Pelger–Huët anomaly
B. Pernicious anemia
C. AIHA
D. Sideroblastic anemia
27. A patient’s peripheral blood smear reveals numerous NRBCs, marked variation of RBC
morphology, and pronounced polychromasia. In addition to decreased Hgb and decreased Hct
values, what other CBC parameters may be anticipated?
A. Reduced PLTs
B. Increased MCHC
C. Increased MCV
D. Decreased RDW
28. What RBC inclusion may be seen in the peripheral blood smear from a patient
postsplenectomy?
A. Toxic granulation
B. Howell–Jolly bodies
C. Malarial parasites
D. Siderotic granules
29. Reticulocytosis usually indicates: A. Response to inflammation
B. Neoplastic process
C. Aplastic anemia
D. RBC regeneration
30. Hereditary pyropoikilocytosis (HP) is an RBC membrane defect characterized by: A.
Increased pencil-shaped cells
B. Increased oval macrocytes
C. Misshapen budding fragmented cells
D. Bite cells

1.3
1. The osmotic fragility test result in a patient with thalassemia major would most likely show:
A. Increased hemolysis
B. Decreased hemolysis
C. Normal resistance to hemolysis
D. Decreased hemolysis after incubation at 37°C
2. All of the following are characteristic findings in a patient with IDA except: A. Microcytic,
hypochromic RBC morphology
B. Decreased serum iron and ferritin levels
C. Decreased total iron-binding capacity (TIBC)
D. Increased RBC protoporphyrin
3. IDA may be distinguished from anemia of chronic infection by: A. Serum iron level
B. RBC morphology
C. RBC indices
D. TIBC
4. Which anemia has RBC morphology similar to that seen in IDA? A. Sickle cell anemia
B. Thalassemia syndrome
C. Pernicious anemia
D. HS
5. IDA is characterized by:
A. Decreased plasma iron, decreased % saturation, increased TIBC
B. Decreased plasma iron, decreased plasma ferritin, normal RBC porphyrin
C. Decreased plasma iron, decreased % saturation, decreased TIBC
D. Decreased plasma iron, increased % saturation, decreased TIBC
6. Storage iron is usually best determined by:
A. Serum transferrin levels
B. Hgb values
C. Myoglobin values
D. Serum ferritin levels
7. All of the following are associated with sideroblastic anemia except: A. Increased serum iron
B. Ringed sideroblasts
C. Hypochromic anemia
D. Decreased serum ferritin
8. What is the basic hematological defect seen in patients with thalassemia major? A. DNA
synthetic defect
B. Hgb structure
C. β-chain synthesis
D. Hgb phosphorylation
9. Which of the following is the primary Hgb in patients with thalassemia major?
A. Hgb D
B. Hgb A
C. Hgb C
D. Hgb F
10. A patient has an Hct of 30%, an Hgb of 8 g/dL, and a RBC count of 4.0 × 1012/L. What is
the morphological classification of this anemia?
A. Normocytic, normochromic
B. Macrocytic, hypochromic
C. Microcytic, hypochromic
D. Normocytic, hyperchromic
11. In which of the following conditions is Hgb A2 elevated?
A. Hgb H
B. Hgb SC disease
C. β-thalassemia minor
D. Hgb S trait
12. Which of the following parameters may be similar for the anemia of inflammation and IDA?
A. Normocytic indices
B. Decreased serum iron concentration
C. Ringed sideroblasts
D. Pappenheimer bodies

Macrocytic and Normochromic Anemias

1. Which morphological classification is characteristic of megaloblastic anemia? A. Normocytic,
normochromic
B. Microcytic, normochromic
C. Macrocytic, hypochromic
D. Macrocytic, normochromic
2. Which anemia is characterized by lack of intrinsic factor that prevents B12 absorption?
A. Tropical sprue
B. Transcobalamin deficiency
C. Blind loop syndrome
D. Pernicious anemia
3. All of the following are characteristics of megaloblastic anemia except: A. Pancytopenia
B. Elevated reticulocyte count
C. Hypersegmented neutrophils
D. Macrocytic erythrocyte indices
4. A patient with a vitamin B12 anemia is prescribed a high dosage of folate. Which of the
following is expected as a result of this treatment?
A. An improvement in neurological problems
B. An improvement in hematological abnormalities
C. No expected improvement
D. Toxicity of the liver and kidneys
5. Which of the following disorders is associated with ineffective erythropoiesis?
A. G6PD deficiency
B. Liver disease
C. Hgb C disease
D. Megaloblastic anemia
6. A 50-year-old patient is suffering from pernicious anemia. Which of the following laboratory
data are most likely for this patient?
A. RBC = 2.5 × 1012/L; WBC = 12,500/μL (12.5 × 109/L); PLT = 250,000/μL (250 × 109/L)
B. RBC = 4.5 × 1012/L; WBC = 6,500/μL (6.5 × 109/L); PLT = 150,000/μL (150 × 109/L)
C. RBC = 3.0 × 1012/L; WBC = 5,000/μL (5.0 × 109/L); PLT = 750,000/μL (750 × 109/L)
D. RBC = 2.5 × 1012/L; WBC = 2,500/μL (2.5 × 109/L); PLT = 50,000/μL (50 × 109/L)
7. Which of the following may be seen in the peripheral blood smear from a patient with
obstructive liver disease?
A. Schistocytes
B. Macrocytes
C. Howell–Jolly bodies
D. Microcytes
8. The macrocytes typically seen in megaloblastic processes are: A. Crescent shaped
B. Teardrop shaped
C. Oval shaped
D. Pencil shaped
9. Which of the following are most characteristic of the RBC indices associated with
megaloblastic anemias?
A. MCV 99 fL, MCH 28 pg, MCHC 31%
B. MCV 62 fL, MCH 27 pg, MCHC 30%
C. MCV 125 fL, MCH 36 pg, MCHC 34%
D. MCV 78 fL, MCH 23 pg, MCHC 30%
10. A patient has 80 NRBCs per 100 leukocytes. In addition to increased polychromasia on
the peripheral blood smear, what other finding may be present on the CBC?
A. Increased PLTs
B. Increased MCV
C. Increased Hct
D. Increased RBC count

1.4
1. Which of the following is an unusual complication that may occur in infectious
mononucleosis?
A. Splenic infarctions
B. Dactylitis
C. Hemolytic anemia
D. Giant PLTs
2. In a patient with HIV infection, one should expect to see: A. Shift to the left in WBCs
B. Target cells
C. Reactive lymphocytes
D. Pelgeroid cells
3. Which inclusions may be seen in leukocytes? A. Döhle bodies
B. Basophilic stippling
C. Malarial parasites
D. Howell–Jolly bodies
4. Which of the following is contained in the primary granules of the neutrophil? A. Lactoferrin
B. Myeloperoxidase
C. Histamine
D. Alkaline phosphatase
5. What is the typical reference range for relative lymphocyte percentage in the peripheral blood
smear from a 1-year-old child?
A. 1%–6%
B. 27%–33%
C. 35%–58%
D. 50%–70%
6. Qualitative and quantitative neutrophil changes noted in response to infection include all of
the following except:
A. Neutrophilia
B. Pelgeroid hyposegmentation
C. Toxic granulation
D. Vacuolization
7. Neutropenia is present in patients with which absolute neutrophil count? A. Less than 1.5 ×
109/L
B. Less than 5.0 × 109/L
C. Less than 10.0 × 109/L
D. Less than 15.0 × 109/L
8. The morphological characteristic(s) associated with Chédiak–Higashi syndrome is (are): A.
Pale blue cytoplasmic inclusions
B. Giant lysosomal granules
C. Small, dark-staining granules and condensed nuclei
D. Nuclear hyposegmentation
9. The familial condition of Pelger–Huët anomaly is important to recognize because this disorder
must be differentiated from:
A. Infectious mononucleosis
B. May–Hegglin anomaly
C. A shift-to-the-left increase in immature granulocytes
D. G6PD deficiency
10. SITUATION: A differential shows reactive lymphocytes, and the physician suspects that a
viral infection is the cause. What is the expected laboratory finding in a patient with a
cytomegalovirus (CMV) infection?
A. Heterophile antibody: positive
B. Epstein–Barr virus (EBV)–immunoglobulin M (IgM): positive
C. Direct antiglobulin test (DAT): positive
D. CMV–IgM: positive
11. Neutrophil phagocytosis and particle ingestion are associated with an increase in O2
utilization called respiratory burst. What are the two most important products of this biochemical
reaction?
A. Hydrogen peroxide (H2O2) and superoxide anion (O2–)
B. Lactoferrin and NADPH oxidase
C. Cytochrome b and collagenase
D. Alkaline phosphatase and ascorbic acid
12. Which of the morphological findings are characteristic of reactive lymphocytes?
A. High nuclear:cytoplasmic (N:C) ratio
B. Prominent nucleoli
C. Basophilic cytoplasm
D. All of these options

1.5
1. Auer rods may be seen in all of the following except:
A. Acute myelomonocytic leukemia (M4)
B. Acute lymphoblastic leukemia (ALL)
C. Acute myeloid leukemia without maturation (AML:M1)
D. Acute promyelocytic leukemia (PML; M3)
2. Which type of anemia is usually present in a patient with acute leukemia?
A. Microcytic, hyperchromic
B. Microcytic, hypochromic
C. Normocytic, normochromic
D. Macrocytic, normochromic
3. In leukemia, which term describes the peripheral blood finding of leukocytosis with a shift to
the left, accompanied by NRBCs?
A. Myelophthisis
B. Dysplasia
C. Leukoerythroblastosis
D. Megaloblastosis
4. The basic pathophysiological mechanisms responsible for producing signs and symptoms in
leukemia include all of the following except:
A. Replacement of normal marrow precursors by leukemic cells causing anemia
B. Decrease in functional leukocytes causing infection
C. Hemorrhage secondary to thrombocytopenia
D. Decreased erythropoietin production
5. Which type of acute myeloid leukemia is called the true monocytic leukemia and follows an
acute or subacute course characterized by monoblasts, promonocytes, and monocytes?
A. Acute myeloid leukemia, minimally differentiated B. Acute myeloid leukemia, without
maturation
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia
6. In which age group does ALL occur with the highest frequency? A. 1–15 years
B. 20–35 years
C. 45–60 years
D. 60–75 years
7. Disseminated intravascular coagulation (DIC) is most often associated with which of the
following types of acute leukemia?
A. Acute myeloid leukemia, without maturation
B. Acute promyelocytic leukemia (PML)
C. Acute myelomonocytic leukemia
D. Acute monocytic leukemia
8. An M:E ratio of 10:1 is most often seen in:
A. Thalassemia
B. Leukemia
C. Polycythemia vera (PV)
D. Myelofibrosis
9. Which of the following is a characteristic of Auer rods?
A. They are composed of azurophilic granules
B. They stain positive on periodic acid–Schiff (PAS) staining
C. They are predominantly seen in chronic myelogenous leukemia (CML)
D. They are nonspecific esterase positive
10. SITUATION: The following laboratory values are seen:
WBC = 6.0 × 109/L
RBC = 1.90 × 1012/L
PLT = 130 × 109/L
Hgb = 6.0 g/dL Hct = 18.5%
Serum vitamin B12 and folic acid: normal
WBC Differential
6% PMNs
40% lymphocytes
4% monocytes
50% blasts
Bone Marrow
40% myeloblasts 60% promegaloblasts
40 megaloblastoid NRBCs/100 WBCs
These results are most characteristic of:
A. Pernicious anemia
B. Acute myeloid leukemia, without maturation
C. Acute erythroid leukemia
D. Acute myelomonocytic leukemia
11. A 24-year-old man with Down syndrome presents with fever, pallor, lymphadenopathy, and
hepatosplenomegaly. His CBC results are as follows:
WBC = 10.8 × 109/L
RBC = 1.56 × 1012/L
8% PMNs
Hgb = 3.3 g/dL
25% lymphocytes
67% PAS-positive blasts
These findings are suggestive of:
A. Hodgkin lymphoma
B. Myeloproliferative disorder
C. Leukemoid reaction
D. Acute lymphocytic leukemia
12. SITUATION: A peripheral blood smear shows 75% blasts. These stain positive for both
Sudan Black B (SBB) and peroxidase. Given these values, which of the following disorders is
most likely?
A. Acute myelocytic leukemia (AML)
B. CML
C. Acute undifferentiated leukemia (AUL)
D. ALL
13. In myeloid cells, the stain that selectively identifies phospholipid in the membranes of both
primary and secondary granules is:
A. PAS
B. Myeloperoxidase
C. SBB
D. Terminal deoxynucleotidyl transferase (TdT)
14. Sodium fluoride may be added to the naphthyl ASD acetate (NASDA) esterase reaction.
The fluoride is added to inhibit a positive reaction with:
A. Megakaryocytes
B. Monocytes
C. Erythrocytes
D. Granulocytes
15. Leukemic lymphoblasts reacting with anti–common acute lymphoblastic leukemia antigen
(anti-CALLA) are characteristically seen in:
A. B-cell ALL
B. T-cell ALL
C. Null-cell ALL
D. Common ALL
16. Which of the following reactions are often positive in ALL but are negative in AML? A. TdT
and PAS
B. Chloroacetate esterase and nonspecific esterase
C. SBB and peroxidase
D. New methylene blue and acid phosphatase
17. A patient’s peripheral blood smear and bone marrow both show 70% blasts. These cells are
negative on SBB staining. Given these data, which of the following is the most likely diagnosis?
A. AML
B. Chronic lymphocytic leukemia (CLL)
C. Acute PML
D. ALL
18. Which of the following leukemias are included in the 2008 World Health Organization
classification of myeloproliferative neoplasms (MPN)?
A. CML
B. Chronic neutrophilic leukemia (CNL)
C. Chronic eosinophilic leukemia (CEL)
D. All of these options are classified as MPN
19. In addition to morphology, cytochemistry, and immunophenotyping, the WHO classification
of myelo- and lymphoproliferative disorders is based on which characteristic?
A. Proteomics
B. Cytogenetic abnormalities
C. Carbohydrate-associated tumor antigen production
D. Cell signaling and adhesion markers
20. The WHO classification requires what percentage for the blast count in blood or bone
marrow for the diagnosis of AML?
A. At least 30%
B. At least 20%
C. At least 10%
D. Any percentage
21. What would be the most likely designation by the WHO for AML M2 by the FAB
classification?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)
22. What would be the most likely designation by the WHO for AML M3 by the FAB
classification?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)
23. Which AML cytogenetic abnormality is associated with AML M4 with marrow eosinophilia
under the WHO classification of AML with recurrent genetic abnormalities?
A. AML with t(15;17)
B. AML with mixed lineage
C. AML with t(8;21)
D. AML with inv(16)
24. What would be the most likely classification by the WHO for AML M7 by the FAB
classification?
A. Acute myeloid leukemias with recurrent genetic abnormalities
B. Acute myeloid leukemia with multilineage dysplasia
C. Acute megakaryoblastic leukemia classified under AML (not otherwise categorized)
D. Acute leukemias of ambiguous lineage

1.6
1. Repeated phlebotomy in patients with PV may lead to the development of:
A. Folic acid deficiency
B. Sideroblastic anemia
C. IDA
D. Hemolytic anemia
2. In ET, the PLTs are:
A. Increased in number and functionally abnormal
B. Normal in number and functionally abnormal
C. Decreased in number and functional
D. Decreased in number and functionally abnormal
3. Which of the following cells is considered pathognomonic for Hodgkin disease? A. Niemann–
Pick cells
B. Reactive lymphocytes
C. Flame cells
D. Reed–Sternberg (RS) cells
4. In myelofibrosis, the characteristic abnormal RBC morphology is that of:
A. Target cells
B. Schistocytes
C. Teardrop-shaped cells
D. Ovalocytes
5. PV is characterized by:
A. Increased plasma volume
B. Pancytopenia
C. Decreased O2 saturation
D. Absolute increase in total RBC mass
6. Features of secondary polycythemia include all of the following except:
A. Splenomegaly
B. Decreased O2 saturation
C. Increased RBC mass
D. Increased erythropoietin
7. Erythrocytosis in relative polycythemia occurs because of:
A. Decreased arterial O2 saturation
B. Decreased plasma volume of circulating blood
C. Increased erythropoietin levels
D. Increased erythropoiesis in bone marrow
8. In PV, what is characteristically seen in peripheral blood?
A. Panmyelosis
B. Pancytosis
C. Pancytopenia
D. Panhyperplasia
9. Leukocyte alkaline phosphatase (LAP) staining performed on a patient gives the following
results:
10(0) 48(1+) 38(2+) 3(3+) 1(4+)
Calculate the LAP score.
A. 100
B. 117
C. 137
D. 252
10. CML is distinguished from leukemoid reaction by which of the following?
A. CML: low LAP; leukemoid: high LAP
B. CML: high LAP; leukemoid: low LAP
C. CML: high WBC; leukemoid: normal WBC
D. CML: high WBC; leukemoid: higher WBC
11. Which of the following occurs in idiopathic myelofibrosis (IMF)?
A. Myeloid metaplasia
B. Leukoerythroblastosis
C. Fibrosis of bone marrow
D. All of these options
12. What influence does the Philadelphia (Ph1) chromosome have on the prognosis of patients
with CML?
A. It is not predictive
B. The prognosis is better if Ph1 is present
C. The prognosis is worse if Ph1 is present
D. The disease usually transforms into AML when Ph1 is present
13. Which of the following is (are) commonly found in CML? A. Many teardrop-shaped cells
B. Intense LAP staining
C. A decrease in granulocytes
D. An increase in basophils
14. In which of the following conditions does LAP show the least activity?
A. Leukemoid reactions
B. IMF
C. PV
D. CML
15. A striking feature of the peripheral blood of a patient with CML is:
A. Profusion of bizarre blast cells
B. Normal number of typical granulocytes
C. Presence of granulocytes at different stages of development
D. Pancytopenia
16. Which of the following is often associated with CML but not with AML?
A. Infections
B. WBCs greater than 20.0 × 109/L
C. Hemorrhage
D. Splenomegaly
17. Multiple myeloma and Waldenström macroglobulinemia have all of the following in common
except:
A. Monoclonal gammopathy
B. Hyperviscosity of blood
C. Bence–Jones protein in urine
D. Osteolytic lesions
18. What is the characteristic finding seen in the peripheral blood smear from a patient with
multiple myeloma?
A. Microcytic hypochromic cells
B. Intracellular inclusion bodies
C. Rouleaux
D. Hypersegmented neutrophils
19. All of the following are associated with the diagnosis of multiple myeloma except: A. Marrow
plasmacytosis
B. Lytic bone lesions
C. Serum and/or urine M component (monoclonal protein)
D. Ph1 chromosome
20. Multiple myeloma is most difficult to distinguish from: A. CLL
B. Acute myelogenous leukemia
C. Benign monoclonal gammopathy
D. Benign adenoma
21. The pathology of multiple myeloma includes which of the following?
A. Expanding plasma cell mass
B. Overproduction of monoclonal immunoglobulins
C. Production of osteoclast activating factor (OAF) and other cytokines
D. All of these options
22. Waldenström macroglobulinemia is a malignancy of the:
A. Lymphoplasmacytoid cells
B. Adrenal cortex
C. Myeloblastic cell lines
D. Erythroid cell precursors
23. Cells that exhibit positive staining with acid phosphatase and are not inhibited by tartaric
acid are characteristically seen in:
A. Infectious mononucleosis
B. Infectious lymphocytosis
C. Hairy cell leukemia (HCL)
D. T-cell acute lymphoblastic leukemia
24. The JAK2(V617F) mutation may be positive in all of the following chronic myeloproliferative
disorders except:
A. ET
B. IMF
C. PV
D. CML
25. All of the following are major criteria for the 2008 WHO diagnostic criteria for ET except:
A. PLT count 450 × 109/L or greater
B. Megakaryocyte proliferation with large and mature morphology and no or little
granulocyte or erythroid proliferation
C. Demonstration of JAK2(V617F) or other clonal marker
D. Evidence of clonality

1.7
1. A 19-year-old man came to the emergency department with severe joint pain, fatigue, cough,
and fever. Review the following laboratory results:
WBCs 21.0 × 109/L
RBCs 3.23 × 1012/L
Hgb 9.6 g/dL
PLT 252 × 109/L
Differential: 17 band neutrophils; 75 segmented neutrophils; 5 lymphocytes; 2 monocytes; 1
eosinophil; 26 NRBCs
What is the corrected WBC count?
A. 8.1 × 109/L
B. 16.7 × 109/L
C. 21.0 × 109/L
D. 80.8 × 109/L
2. A manual WBC count is performed. Eighty WBCs are counted in the four large corner
squares of a Neubauer hemacytometer. The dilution is 1:100. What is the total WBC count?
A. 4.0 × 109/L
B. 8.0 × 109/L
C. 20.0 × 109/L
D. 200.0 × 109/L
3. A manual RBC count is performed on pleural fluid. The RBC count in the large center square
of the Neubauer hemacytometer is 125, and the dilution is 1:200. What is the total RBC count?
A. 27.8 × 109/L
B. 62.5 × 109/L
C. 125.0 × 109/L
D. 250.0 × 109/L
5. Review the following automated CBC values.
WBC = 17.5 × 109/L (flagged) MCV = 86.8 fL RBC = 2.89 × 1012/L MCH = 28.0 pg
Hgb = 8.1 g/dL MCHC = 32.3%. Hct = 25.2% PLT = 217 × 109/L
Many sickle cells were observed on review of the peripheral blood smear. On the basis of this
finding and the results provided, what automated parameter of this patient is most likely
inaccurate, and what follow-up test should be done to accurately assess this parameter?
A. MCV/perform reticulocyte count
B. Hct/perform manual Hct
C. WBC/perform manual WBC count
D. Hgb/perform serum–saline replacement
6. Review the following CBC results for a 2-day-old infant:
WBC = 15.2 × 109/L RBC = 5.30 × 1012/L Hgb = 18.5 g/dL
Hct = 57.9%
These results indicate:
A. Macrocytic anemia
B. Microcytic anemia
C. Liver disease
D. Normal values for a 2-day-old infant

CHAPTER 2: Hemostasis and Thrombosis

1. Which of the following initiates in vivo coagulation by activation of factor VII?
A. Protein C
B. Tissue factor (TF)
C. Plasmin activator
D. Thrombomodulin (TM)
2. Which of the following clotting factors plays a role in clot formation in vitro, but not in vivo?
A. Factor VIIa
B. Factor IIa
C. Factor XIIa
D. Factor Xa
3. The anticoagulant of choice for most routine coagulation studies is:
A. Sodium oxalate
B. Sodium citrate
C. Heparin
D. Ethylenediaminetetraacetic acid (EDTA)
4. Which anticoagulant:blood ratio is correct for coagulation procedures? A. 1:4
B. 1:5
C. 1:9
D. 1:10
5. Which results would be expected for PT and APTT in a patient with polycythemia? A. Both
prolonged
B. Both shortened
C. Normal PT, prolonged APTT
D. Both normal
6. Which reagents are used in the PT test?
A. Thromboplastin and sodium chloride
B. Thromboplastin and potassium chloride
C. Thromboplastin and calcium
D. Actin and calcium chloride
7. Which test would be abnormal in a patient with factor X deficiency?
A. PT only
B. APTT only
C. PT and APTT
D. Thrombin time (TT)
8. Which clotting factor is not measured by the PT and APTT tests?
A. Factor VIII
B. Factor IX
C. Factor V
D. Factor XIII
9. A modification of which procedure can be used to measure fibrinogen?
A. PT
B. APTT
C. TT
D. Fibrin degradation products
10. Which of the following characterizes vitamin K?
A. It is required for biological activity of fibrinolysis
B. Its activity is enhanced by heparin therapy
C. It is required for carboxylation of glutamate residues of some coagulation factors
D. It is made by endothelial cells
11. Which fragments of fibrin clot degradation are measured by the D-dimer test?
A. Fragments X and Y
B. Fibrinopeptide A and B
C. Fragments D and E
D. The D-D domains
12. Which of the following clotting factors are measured by the APTT test?
A. Factors II, VII, IX, X
B. Factors VII, X, V, II, I
C. Factors XII, XI, IX, VIII, X, V, II, I
D. Factors XII, VII, X, V, II, I
13. Which coagulation test(s) would be abnormal in a patient with vitamin K deficiency?
A. PT only
B. PT and APTT
C. Fibrinogen level
D. TT
14. Which of the following is correct regarding the international normalized ratio (INR)? A. It
uses the international sensitivity ratio (ISR)
B. It standardizes PT results
C. It standardizes APTT results
D. It is used to monitor heparin therapy
15. Which of the following is referred to as an endogenous activator of plasminogen?
A. Streptokinase
B. Transamidase
C. Tissue plasminogen activator (tPA)
D. tPA inhibitor
16. Which protein is the primary inhibitor of the fibrinolytic system?
A. Protein C
B. Protein S
C. α2-Antiplasmin
D. α2-Macroglobulin
17. Which of the following statements is correct regarding the D-dimer test?
A. Levels are decreased in DIC
B. Test detects polypeptides A and B
C. Test detects fragments D and E
D. Test has a negative predictive value
18. A protein that plays a role in both coagulation and PLT aggregation is:
A. Factor I
B. Factor VIII
C. Factor IX
D. Factor XI
19. A standard 4.5-mL blue-top tube filled with 3.0 mL of blood was submitted to the laboratory
for PT and APTT tests. The sample is from a patient undergoing surgery the following morning
for a tonsillectomy. Which of the following is the necessary course of action by the medical
laboratory scientist?
A. Run both tests in duplicate and report the average result
B. Reject the sample and request a new sample
C. Report the PT result
D. Report the APTT result
20. Which statement is correct regarding sample storage for the PT test? A. Stable for 24 hours
if the sample is capped
B. Stable for 24 hours if the sample is refrigerated at 4°C
C. Stable for 4 hours if the sample is stored at 4°C
D. Should be run within 8 hours
21. In primary fibrinolysis, the fibrinolytic activity results in response to:
A. Increased fibrin formation
B. Spontaneous activation of fibrinolysis
C. Increased fibrin monomers
D. DIC
22. Plasminogen deficiency is associated with:
A. Bleeding
B. Thrombosis
C. Increased fibrinolysis
D. Increased coagulation
23. Which of the following clotting factors are activated by thrombin that is generated by tissue
pathway (TF-VIIa)?
A. Factors XII, XI
B. Factors XII, I
C. Factors I,
D. Factors V, VIII
24. Which substrate is used in a chromogenic factor assay?
A. p-nitroaniline (pNa)
B. Chlorophenol red
C. Prussian blue
D. Ferricyanide
25. Which of the following antibodies is used in the D-dimer assay?
A. Polyclonal antibody directed against X and Y fragments
B. Polyclonal antibody directed against D-dimer
C. Monoclonal antibody against D and E fragments
D. Monoclonal antibody against D-dimer

2.2
1. Thrombotic thrombocytopenic purpura (TTP) is characterized by:
A. Prolonged PT
B. Increased PLT aggregation
C. Thrombocytosis
D. Prolonged APTT
2. Thrombocytopenia may be associated with:
A. Splenectomy
B. Hypersplenism
C. Acute blood loss
D. Increased proliferation of pluripotent stem cells
3. Aspirin prevents PLT aggregation by inhibiting the action of which enzyme?
A. Phospholipase
B. Cyclo-oxygenase
C. Thromboxane A2 (TXA2) synthetase
D. Prostacyclin synthetase
4. Normal PLT adhesion depends on:
A. Fibrinogen
B. Glycoprotein Ib
C. Glycoprotein IIb–IIIa complex
D. Calcium
5. Which of the following test results is normal in a patient with classic von Willebrand disease?
A. PLT aggregation
B. APTT
C. PLT count
D. Factor VIII:C and von Willebrand factor (VWF) levels
6. Bernard–Soulier syndrome is associated with: A. Decreased factor IX
B. Decreased factor VIII
C. Thrombocytopenia and giant PLTs
D. Abnormal PLT function test results
7. When performing PLT aggregation studies, which set of PLT aggregation results would most
likely be associated with Bernard–Soulier syndrome?
A. Normal PLT aggregation to collagen, adenosine diphosphate (ADP), and ristocetin
B. Normal PLT aggregation to collagen, ADP, and epinephrine (EPI); decreased aggregation
to ristocetin
C. Normal PLT aggregation to EPI and ristocetin; decreased aggregation to collagen and
ADP
D. Normal PLT aggregation to EPI, ristocetin, and collagen; decreased aggregation to ADP 8.
Which set of PLT responses would be most likely associated with Glanzmann thrombasthenia?
A. Normal PLT aggregation to ADP and ristocetin; decreased aggregation to collagen
B. Normal PLT aggregation to collagen; decreased aggregation to ADP and ristocetin
C. Normal PLT aggregation to ristocetin; decreased aggregation to collagen, ADP, and EPI
D. Normal PLT aggregation to ADP; decreased aggregation to collagen and ristocetin
9. Which of the following is a characteristic of acute immune thrombocytopenic purpura?
A. Spontaneous remission within a few weeks
B. Predominantly seen in adults
C. Nonimmune PLT destruction
D. Insidious onset
10. TTP differs from DIC in that:
A. APTT is normal in TTP but prolonged in DIC
B. Schistocytes are not present in TTP but are present in DIC
C. PLT count is decreased in TTP but normal in DIC
D. PT is prolonged in TTP but decreased in DIC
11. Several hours after birth, a baby boy develops petechiae and purpura and hemorrhagic
diathesis. The PLT count is 18 × 109/L. What is the most likely explanation for the low PLT
count?
A. Drug-induced thrombocytopenia
B. Secondary thrombocytopenia
C. Neonatal alloimmune thrombocytopenia
D. Neonatal DIC
12. Which of the following is associated with post-transfusion purpura (PTP)?
A. Nonimmune thrombocytopenia/alloantibodies
B. Immune-mediated thrombocytopenia/alloantibodies
C. Immune-mediated thrombocytopenia/autoantibodies
D. Nonimmune-mediated thrombocytopenia/autoantibodies
13. Hemolytic uremic syndrome (HUS) is associated with:
A. Fever, thrombocytosis, anemia, and renal failure
B. Fever, granulocytosis, and thrombocytosis
C. Escherichia coli 0157:H7
D. Leukocytosis and thrombocytosis
14. Storage pool deficiencies are defects of:
A. PLT adhesion
B. PLT aggregation
C. PLT granules
D. PLT production
15. Lumi-aggregation measures:
A. PLT aggregation only
B. PLT aggregation and adenosine triphosphate (ATP) release
C. PLT adhesion
D. PLT glycoprotein Ib
16. Neurological findings may be commonly associated with which of the following disorders?
A. HUS
B. TTP
C. ITP
D. PTP
17. Which of the following is correct regarding acquired TTP?
A. Autoimmune disease
B. Decreased VWF
C. Decreased PLT aggregation
D. Decreased PLT adhesion
18. Hereditary hemorrhagic telangiectasia is a disorder of:
A. PLTs
B. Clotting proteins
C. Fibrinolysis
D. Connective tissue
19. Which of the following prevents PLT aggregation?
A. TXA2
B. Thromboxane B2
C. Prostacyclin
D. Antithrombin (AT)
20. Which defect characterizes Gray syndrome?
A. PLT adhesion defect
B. Dense granule defect
C. Alpha granule defect
D. Coagulation defect
21. The P2Y12 ADP receptor agonist assay may be used to monitor PLT aggregation inhibition
to which of the following drugs?
A. Warfarin
B. Heparin
C. Low-molecular-weight heparin (LMWH)
D. Clopidogrel (Plavix)
22. Which of the following instruments can be used to evaluate PLT function?
A. PLT aggregometer
B. VerifyNow
C. PFA-100
D. All of the above
23. Which of the following PLT aggregating agents demonstrates a monophasic aggregation
curve when used in the optimal concentration?
A. Thrombin
B. Collagen
C. ADP
D. EPI

2.3
1. The APTT is sensitive to a deficiency of which clotting factor? A. Factor VII
B. Factor X
C. PF3
D. Calcium
2. Which test result would be normal in a patient with dysfibrinogenemia? A. TT
B. APTT
C. PT
D. Immunologic fibrinogen level
3. A patient with a prolonged PT is given intravenous vitamin K. PT is corrected to normal after
24 hours. Which clinical condition most likely caused these results?
A. Necrotic liver disease
B. Factor X deficiency
C. Fibrinogen deficiency
D. Obstructive jaundice
4. Which factor deficiency is associated with prolonged PT and APTT?
A. Factor X
B. Factor VIII
C. Factor IX
D. Factor XI
5. Prolonged APTT is corrected with factor VIII–deficient plasma but not with factor IX– deficient
plasma. Which factor is deficient?
A. Factor V
B. Factor VIII
C. Factor IX
D. Factor X
6. Which of the following is a characteristic of classic hemophilia A?
A. Abnormal PLT aggregation
B. Autosomal recessive inheritance
C. Mild to severe bleeding episodes
D. Prolonged PT
7. Refer to the following results:
PT = prolonged
APTT = prolonged PLT count = decreased
Which disorder may be indicated? A. Factor VIII deficiency
B. von Willebrand disease
C. DIC
D. Factor IX deficiency
Hemostasis/Correlate clinical and laboratory data/Coagulation disorders/3
8. Which of the following is a predisposing condition for the development of DIC? A.
Adenocarcinoma
B. Idiopathic thrombocytopenic purpura (ITP)
C. Post transfusion purpura (PTP)
D. Heparin-induced thrombocytopenia (HIT)
Hemostasis/Correlate clinical and laboratory data/DIC/1
9. Factor XII deficiency is associated with: A. Bleeding episodes
B. Epistaxis
C. Decreased risk of thrombosis
D. Increased risk of thrombosis
10. The following results were obtained on a patient: normal PLT count and function, normal PT,
and prolonged APTT. Which of the following disorders is most consistent with these results?
A. Hemophilia A
B. Bernard–Soulier syndrome
C. von Willebrand disease
D. Glanzmann thrombasthenia
11. The following laboratory results were obtained from a 40-year-old woman: PT = 20 sec;
APTT = 50 sec; TT = 18 sec. What is the most probable diagnosis?
A. Factor VII deficiency
B. Factor VIII deficiency
C. Factor X deficiency
D. Hypofibrinogenemia
12. When performing a factor VIII activity assay, a patient’s plasma is mixed with:
A. Normal patient plasma
B. Factor VIII–deficient plasma
C. Plasma with a high concentration of factor VIII
D. Normal control plasma
13. The most suitable product for treatment of factor VIII deficiency is:
A. Fresh frozen plasma (FFP)
B. Factor VIII concentrate
C. Prothrombin complex concentrate
D. Factor V Leiden
14. Which of the following is associated with an abnormal PLT aggregation test result?
A. Factor VIII deficiency
B. Factor VIII inhibitor
C. Lupus anticoagulant
D. Afibrinogenemia
15. Refer to the following results:
PT = normal
APTT = prolonged
PLT count = normal
PLT aggregation to ristocetin = abnormal
Which of the following disorders may be indicated?
A. Factor VIII deficiency
B. DIC
C. von Willebrand disease
D. Factor IX deficiency
16. Which results are associated with hemophilia A?
A. Prolonged APTT, normal PT
B. Prolonged PT and APTT
C. Prolonged PT, normal APTT
D. Normal PT and APTT
17. Fibrin monomers are increased in which of the following conditions?
A. Primary fibrinolysis
B. DIC
C. Factor VIII deficiency
D. Fibrinogen deficiency
18. Which of the following is associated with multiple factor deficiencies?
A. An inherited disorder of coagulation
B. Severe liver disease
C. Dysfibrinogenemia
D. Lupus anticoagulant
19. Normal PT and APTT results in a patient with poor wound healing may be associated with:
A. Factor VII deficiency
B. Factor VIII deficiency
C. Factor XII deficiency
D. Factor XIII deficiency
20. Fletcher factor (prekallikrein) deficiency may be associated with: A. Bleeding
B. Thrombosis
C. Thrombocytopenia
D. Thrombocytosis
21. One of the complications associated with a severe hemophilia A is:
A. Hemarthrosis
B. Mucous membrane bleeding
C. Mild bleeding during surgery
D. Immune-mediated thrombocytopenia
22. The most common subtype of classic von Willebrand disease is:
A. Type 1
B. Type 2A
C. Type 2B
D. Type 3
23. Prolonged APTT and PT are corrected when mixed with normal plasma. Which factor is
most likely deficient?
A. Factor VIII
B. Factor V
C. Factor XI
D. Factor IX

2.4
1. Which characteristic describes antithrombin (AT)?
A. It is synthesized in megakaryocytes
B. It is activated by protein C
C. It is a cofactor of heparin
D. It is a pathological inhibitor of coagulation
2. Which laboratory test is affected by heparin therapy?
A. Thrombin time
B. Fibrinogen assay
C. Protein C assay
D. Protein S assay
3. Abnormal APTT caused by a pathological circulating anticoagulant is:
A. Corrected with factor VIII–deficient plasma
B. Corrected with factor IX–deficient plasma
C. Corrected with normal plasma
D. Not corrected with normal plasma
4. The lupus anticoagulant affects which of the following tests?
A. Factor VIII assay
B. Factor IX assay
C. VWF assay
D. Phospholipid-dependent assays
5. Which statement about warfarin (Coumadin) is accurate?
A. It is a vitamin B antagonist
B. It is not recommended for pregnant and lactating women
C. It needs AT as a cofactor
D. APTT test is used to monitor its dosage
6. Which statement regarding protein C is correct?
A. It is a vitamin K–independent zymogen
B. It is activated by fibrinogen
C. It activates cofactors V and VIII
D. Its activity is enhanced by protein S
7. Which of the following is an appropriate screening test for the diagnosis of lupus
anticoagulant?
A. Thrombin time
B. Diluted Russell viper venom test (DRVVT)
C. D-dimer test
D. Fibrinogen assay
8. Which of the following is most commonly associated with activated protein C resistance
(APCR)?
A. Bleeding
B. Thrombosis
C. Epistaxis
D. Menorrhagia
9. A 50-year-old man has been on heparin for the past 7 days. Which combination of tests is
expected to be abnormal?
A. PT and APTT only B. APTT, TT only
C. APTT, TT, fibrinogen assay
D. PT, APTT, TT
10. Which of the following drugs inhibits ADP-mediated PLT aggregation?
A. Heparin
B. Warfarin
C. Aspirin
D. Prasugrel
11. Thrombin–TM complex is necessary for activation of:
A. Protein C
B. AT
C. Protein S
D. Factors V and VIII
12. Which test is used to monitor heparin therapy?
A. INR
B. Chromogenic anti–factor Xa assay
C. TT
D. PT
13. Which test is commonly used to monitor warfarin therapy?
A. INR
B. APTT
C. TT
D. Ecarin time
14. Which clotting factors (cofactors) are inhibited by protein S? A. Factors V and X
B. Factors Va and VIIIa
C. Factors VIII and IX
D. Factors VIII and X
15. Which drug promotes fibrinolysis?
A. Warfarin
B. Heparin
C. Urokinase
D. Aspirin
16. Diagnosis of lupus anticoagulant is confirmed by which of the following criteria?
A. Decreased APTT
B. Correction of APPT by mixing studies
C. Neutralization of the antibody by high concentration of phospholipids
D. Confirmation that abnormal coagulation tests are related to factor deficiencies
17. Which of the following abnormalities is consistent with the presence of lupus anticoagulant?
A. Decreased APTT/bleeding complications
B. Prolonged APTT/thrombosis
C. Prolonged APTT/thrombocytosis
D. Thrombocytosis/thrombosis
18. Which of the following is a characteristic of LMWH?
A. Generally requires monitoring
B. Specifically acts on factor Va
C. Has a longer half-life compared with unfractionated heparin (UFH)
D. Can be used as a fibrinolytic agent
19. Which of the following tests is most likely to be abnormal in patients taking aspirin?
A. PLT morphology
B. PLT count
C. PLT aggregation
D. PT
20. Which of the following is associated with AT deficiency?
A. Thrombocytosis
B. Thrombosis
C. Thrombocytopenia
D. Bleeding
21. Which of the following may be associated with thrombotic events?
A. Decreased protein C
B. Increased fibrinolysis
C. Afibrinogenemia
D. Idiopathic thrombocytopenic purpura
22. Aspirin resistance may be associated with:
A. Bleeding
B. Factor VIII deficiency
C. Thrombosis
D. Thrombocytosis
23. Prolonged TT is indicative of which of the following antithrombotic agents?
A. Prasugrel
B. Clopidogrel
C. Aspirin
D. Heparin
24. Screening tests for thrombophilia should be performed on:
A. All pregnant women because of the risk of thrombosis
B. Patients with a negative family history
C. Patients with thrombotic events occurring at a young age
D. Patients who are receiving anticoagulant therapy
25. Prothrombin G20210A is characterized by which of the following causes and conditions?
A. Single mutation of prothrombin molecule/bleeding
B. Single mutation of prothrombin molecule/thrombosis
C. Decreased levels of prothrombin in plasma/thrombosis
D. Increased levels of prothrombin in plasma/bleeding
26. Factor V Leiden promotes thrombosis by preventing:
A. Inactivation of factor Va
B. Activation of factor V
C. Activation of protein C
D. Activation of protein S
27. What is the approximate incidence of antiphospholipid antibodies in the general population?
A. Less than 1%
B. 1%–2%
C. 3%–8%
D. 10%–15%
28. Which of the following laboratory tests is helpful in the diagnosis of aspirin resistance?
A. APTT
B. PT
C. PLT count and morphology
D. PLT aggregation
29. Which of the following complications may occur as a result of decreased tissue factor
pathway inhibitor (TFPI)?
A. Increased episodes of hemorrhage
B. Increased risk of thrombosis
C. Impaired PLT plug formation
D. Immune thrombocytopenia
30. Factor VIII inhibitors occur in __________ of patients with factor VIII deficiency.
A. 40%–50%
B. 30%–40%
C. 25%–30%
D. 20%–25%
31. Which therapy and resulting mode of action are appropriate for the treatment of a patient
with a high titer of factor VIII inhibitors?
A. Factor VIII concentrate to neutralize the antibodies
B. Recombinant factor VIIa (rVIIa) to activate factor X
C. Factor X concentrate to activate the common pathway
D. FFP to replace factor VIII
32. The Bethesda assay is used for which determination?
A. Lupus anticoagulant titer
B. Factor VIII inhibitor titer
C. Factor V Leiden titer
D. Protein S deficiency
33. Hyperhomocysteinemia may be a risk factor for:
A. Bleeding
B. Thrombocythemia
C. Thrombosis
D. Thrombocytopenia
34. Which drug may be associated with DVT?
A. Aspirin
B. tPA
C. Oral contraceptives
D. Clopidogrel (Plavix)
35. Argatroban may be used as an anticoagulant drug in patients with:
A. DVT
B. Hemorrhage
C. TTP
D. Thrombocytosis
36. Heparin-induced thrombocytopenia (HIT) results from:
A. Antibodies to heparin
B. Antibodies to PLTs
C. Antibodies to PF4
D. Antibodies to heparin–PF4 complex
37. Which laboratory test is used to screen for APCR?
A. Mixing studies with normal plasma
B. Mixing studies with factor-deficient plasma
C. Modified APTT with and without APC
D. Modified PT with and without APC
38. Ecarin clotting time may be used to monitor:
A. Heparin therapy
B. Warfarin therapy
C. Fibrinolytic therapy
D. Bivalirudin
39. Which of the following may interfere with the APCR screening test?
A. Lupus anticoagulant
B. Protein C deficiency
C. AT deficiency
D. Protein S deficiency
40. Thrombophilia may be associated with which of the following disorders?
A. Afibrinogenemia
B. Hypofibrinogenemia
C. Factor VIII inhibitor
D. Hyperfibrinogenemia
41. Which of the following anticoagulant drugs can be used in patients with HIT?
A. Warfarin
B. Heparin
C. Aspirin
D. Argatroban
42. Which of the following is the preferred method to monitor heparin therapy at the point of care
during cardiac surgery?
A. APTT
B. ACT
C. PT
D. TT
43. Mrs. Smith has the following laboratory results and no history of bleeding:
APTT = prolonged
APTT results on a 1:1 mixture of the patient’s plasma with normal plasma:
Preincubation: prolonged APTT
2-hour incubation: prolonged APTT
These results are consistent with:
A. Factor VIII deficiency
B. Factor VIII inhibitor
C. Lupus anticoagulant
D. Protein C deficiency
44. Which test may be used to monitor LMWH therapy?
A. APTT
B. INR
C. Anti–factor Xa heparin assay
D. ACT

2.5
1. A 3-year-old male was admitted with scattered petechiae and epistaxis. The patient had
normal growth and had no other medical problems except for chickenpox 3 weeks earlier. His
family history was unremarkable.
Laboratory Results:
Patient Reference Range
PT 11 sec 10–13 sec
APTT 32 sec 28–37 sec
PLT count 18 × 103/μL L 150–450 × 103/μL
These clinical manifestations and laboratory results are consistent with which condition?
A. TTP
B. DIC
C. ITP
D. HUS
2. A 12-year-old white male has the following symptoms: visible bruising on arms and
legs, bruising after sports activities, and excessive postoperative hemorrhage after tonsillectomy
3 months ago. His family history revealed that his mother suffers from heavy menstrual
bleeding, and his maternal grandfather had recurrent nosebleeds and bruising.
These clinical manifestations and laboratory results are consistent with which diagnosis?
A. Factor VIII deficiency
B. von Willebrand disease
C. Glanzmann thrombasthenia
D. Bernard-Soulier syndrome
3. The following results are obtained from a patient who developed severe bleeding:
Prolonged PT and APTT
PLT count = 100 × 109/L
Fibrinogen = 40 mg/dL
Which of the following blood products should be recommended for transfusion?
A. Factor VIII concentrate
B. PLTs
C. FFP
D. Cryoprecipitate
4. A 30-year-old woman develops signs and symptoms of thrombosis in her left lower leg after 5
days of heparin therapy. The patient had had open-heart surgery 3 days previously and has
been on heparin ever since. Which of the following would be most helpful in making the
diagnosis?
A. Fibrinogen assay
B. PT
C. PLT count
D. Increased heparin dose
5. The following laboratory results were obtained on a 25-year-old woman with menorrhagia
after delivery of her second son. The patient has no previous bleeding history.
Normal PLT count; normal PT; prolonged APTT Mixing of the patient’s plasma with normal
plasma corrected the prolonged APTT on immediate testing. However, mixing followed by 2-
hour incubation at 37°C caused prolonged APTT.
What is the most probable cause of these laboratory results?
A. Lupus anticoagulant
B. Factor VIII deficiency
C. Factor IX deficiency
D. Factor VIII inhibitor
Hemostasis/Evaluate laboratory data to recognize health and disease states/Mixing studies/3
6. A 62-year-old female presents with jaundice and the following laboratory data:
Peripheral blood smear = macrocytosis, target cells
PLT count = 355 × 109/L
PT = 25 sec (reference range = 10–14)
APTT = 65 sec (reference range = 28–36)

Transaminases = elevated (AST:ALT ratio greater than 1)

Total and direct bilirubin = elevated
These clinical presentations and laboratory results are consistent with:
A. Inherited factor VII deficiency
B. DIC
C. Cirrhosis of the liver
D. von Willebrand disease
7. When performing a mixing study, the patient’s APTT is corrected to 12% of normal. What is
the most appropriate interpretation of these findings?
A. The APTT is considered corrected
B. The APTT is considered uncorrected
C. The laboratory protocol should be followed for the interpretation of correction
D. A circulating anticoagulant can be ruled out
8. A standard blue-top tube filled appropriately (with 4.5 mL blood) was submitted to the
laboratory for preoperative PT and APTT testing. The results of both tests were elevated. The
patient’s PT and APTT from the previous day were within normal limits, and he was not on
heparin therapy. Which is the most appropriate first step to investigate the abnormal results?
A. Report the result as obtained
B. Perform a mixing study
C. Check the sample for a clot
D. Report APTT only
9. A plasma sample submitted to the laboratory for PT testing has been stored for 25 hours at
4°C. PT is shortened. What is the most probable cause?
A. Factor VII deficiency
B. Activation of factor VII caused by exposure to cold temperature
C. Lupus inhibitor
D. Factor X inhibitor
10. APTT is not increased in a patient receiving heparin. Which of the following factors may be
associated with the lack of response to heparin therapy in this patient?
A. Protein C deficiency
B. AT deficiency
C. Protein S deficiency
D. Factor VIII deficiency
11. A 50-year-old patient was admitted to the emergency department with a complaint of pain in
the right leg. The leg was red, swollen, and warm to the touch. DVT was suspected, and the
patient was started on heparin therapy. Which of the following is (are) the proper protocol(s) to
evaluate patients receiving heparin therapy?
A. Baseline APTT and PLT count; APTT testing every 4 to 6 hours after the initial heparin bolus
B. Repeat APTT 5 days after heparin therapy to adjust the therapeutic dose
C. Monitor the PLT count daily and every other day after heparin therapy is completed
D. Monitor PT daily to adjust the therapeutic dose
12. A 46-year-old female was admitted to the emergency department with complaints of
headache, dizziness, lethargy, nausea, vomiting, and weakness. The patient had undergone a
gastrectomy procedure 4 months earlier for removal of adenocarcinoma of the stomach and had
been placed on mitomycin therapy. Diagnostic procedures indicated recurrence of the
carcinoma.
These clinical manifestations and laboratory results are consistent with:
A. ITP
B. von Willebrand disease
C. TTP
D. DIC
13. A 1-year-old infant was admitted with recurrent epistaxis for the past 5 days. Past
medical history revealed easy bruising and a severe nosebleed that had occurred when he was
3 months of age, necessitating transfusion therapy. The mother had a severe nosebleed 8 years
ago. The father was reported to bleed easily after lacerations. The patient was transfused with 2
units of packed RBCs on admission.
These clinical manifestations and laboratory results are consistent with which condition?
A. von Willebrand disease
B. Bernard-Soulier syndrome
C. Glanzmann thrombasthenia
D. Factor VIII deficiency
14. Patient History:
A 30-year-old female was referred to the hospital for evaluation for multiple
spontaneous abortions and current complaint of pain and swelling in her right leg. Her family
history is unremarkable.
These clinical manifestations and laboratory results are consistent with:
A. Factor VIII inhibitor
B. Factor VIII deficiency
C. Anticardiolipin antibodies
D. Lupus anticoagulant
15. A 60-year-old patient was admitted to a hospital for a liver biopsy. The biopsy was
scheduled for 11:00 a.m. The coagulation results obtained at the time of admission revealed
prolonged PT with an INR of 4.5. What is the physician’s most appropriate course of action?
A. Proceed with biopsy because prolonged PT is expected in liver disease
B. Postpone the procedure for a couple of days
C. Cancel the procedure and start the patient on vitamin K therapy
D. Put patient on vitamin K therapy and proceed with the procedure immediately
16. A fresh blood sample was sent to the laboratory at 8:00 a.m. for the PT test. At 4:00 p.m.,
the doctor requested for the APTT test to be done on the same sample. What should the
technologist do?
A. Rerun the APTT on the 8:00 a.m. sample and report the result
B. Request a new sample for APTT
C. Run the APTT in duplicate and report the average
D. Mix patient plasma with normal plasma and run the APTT
17. An APTT test is performed on a patient and the result is 50 sec (reference range 27–37
sec). The instrument flags the result because of failure of the delta check. The patient had had
an APTT of 35 sec the previous day. The technologist calls the nursing unit to check whether
the patient is on heparin therapy. The patient is not receiving heparin. What is the next
appropriate step?
A. Check the patient’s family history for inherited factor VIII deficiency
B. Check to see if the patient has received any other anticoagulant medications C. Perform
mixing studies
D. Perform a factor VIII assay
18. A patient was put on heparin therapy postoperatively for prevention of thrombosis. The
patient had the following laboratory results on admission: Platelet count = 350 × 109/L; PT = 12
sec (reference: 10–13 sec); APTT = 35 sec (reference: 28–37). After 6 days of heparin therapy,
the patient complained of pain and swelling in her left leg. Her platelet count dropped to 85 ×
109/L, and her APTT result was 36 sec. The physician suspected HIT and ordered the PLT
aggregation test to be performed immediately. The heparin-induced PLT aggregation test result
was negative. Heparin therapy was continued. Several days later, the patient developed a
massive clot in her left leg that necessitated amputation. Which of the following should have
been recognized or initiated?
A. The patient should have been placed on LMWH
B. The heparin dose should have been increased
C. The negative PLT aggregation does not rule out HIT
D. The patient should have been placed on warfarin therapy
19. A 50-year-old female was admitted to a hospital for hip replacement surgery. Preoperative
tests were performed, and the results showed the following:
Hgb = 13.5 g/dL; Hct = 42%; PT = 12 sec; APTT = 36 sec.
The patient was bleeding during surgery, and postoperative test results revealed the following:
Hgb = 5.0 g/dL; Hct = 16%; PT = 8 sec; APTT = 25 sec.
What steps should be taken before releasing these results?
A. No follow-up steps are needed; report the results as obtained
B. Report Hgb and Hct results, adjust the anticoagulant volume, and redraw a new sample for
PT and APTT
C. Call the nurse and ask if the patient is receiving heparin
D. Because the patient is severely anemic, multiply the PT and APTT results by two and report
the results
20. A 45-year-old woman visited her doctor complaining of easy bruising and menorrhagia
occurring for the past few weeks. The patient had no history of excessive bleeding during child
birth several years earlier or during a tonsillectomy in childhood. Her family history was
unremarkable.
These clinical manifestations and laboratory results are consistent with: A. Factor VIII inhibitor
B. Factor V inhibitor
C. Factor VIII deficiency
D. Lupus anticoagulant