1.

2
Normocytic and Normochromic Anemias
1. Hypersplenism is characterized by:
A. Polycythemia
B. Pancytosis
C. Leukopenia
D. Myelodysplasia
Hematology/Correlate clinical and laboratory data/WBCs/Hypersplenism/2
2. Which of the following organs is responsible for the “pitting process” in RBCs?
A. Liver
B. Spleen
C. Kidney
D. Lymph nodes
Hematology/Apply knowledge of fundamental biological characteristics/Physiology/1
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
Hematology/Apply knowledge of fundamental biological characteristics/RBC microscopic
morphology/2
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
Hematology/Correlate clinical and laboratory data/Hereditary spherocytosis/2
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)
Hematology/Evaluate laboratory data to recognize health and disease states/Special
tests/Osmotic fragility/2
6. The anemia seen in sickle cell disease is usually:
A. Microcytic, normochromic
B. Microcytic, hypochromic
C. Normocytic, normochromic occasionally target cell
D. Normocytic, hypochromic
Hematology/Apply knowledge of fundamental biological characteristics/RBC microscopic
 morphology/Hemoglobinopathy/1

Answers to Questions 1–6

1. C Hypersplenic conditions are generally described by the following four criteria: (1)
cytopenias of one or more peripheral cell lines, (2) splenomegaly, (3) bone marrow
hyperplasia, and (4) resolution of cytopenia by splenectomy.
2. B The spleen is the supreme filter of the body, pitting imperfections from the erythrocyte
without destroying the integrity of the membrane.
3. D Spherocytes lose their deformability because of a defect in spectrin, a membrane
protein, and are therefore prone to splenic sequestration and hemolysis.
4. C Classic features of intravascular hemolysis, such as hemoglobinemia, hemoglobinuria,
or hemosiderinuria, do not occur in HS. The hemolysis seen in HS is an extravascular
process, rather than an intravascular process.
5. D Spherocytic cells have decreased tolerance to swelling and, therefore, hemolyse at a
higher concentration of sodium salt compared with normal RBCs.
6. C Sickle cell disease is a chronic hemolytic anemia classified as a normocytic,
normochromic anemia.

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
Hematology/Apply knowledge of fundamental biological
characteristics/Anemia/Hemoglobinopathy/1
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
Hematology/Apply knowledge of fundamental biological
characteristics/Hemoglobinopathy/1
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
Hematology/Apply knowledge of fundamental biological
characteristics/Anemia/Hemoglobinopathy/1
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
Hematology/Correlate clinical and laboratory data/Hemoglobin electrophoresis/1
11. Which of the following electrophoretic results is consistent with a diagnosis of the sickle
cell trait?
A. Hgb A: 40% Hgb S: 35% Hgb F: 5%
B. Hgb A: 60% Hgb S: 40% Hgb A2: 2%
C. Hgb A: 0% Hgb A2: 5% Hgb F: 95%
D. Hgb A: 80% Hgb S: 10% Hgb A2: 10%
Hematology/Evaluate laboratory data to recognize health and disease/Special
tests/Electrophoresis/2
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
Hematology/Apply knowledge of fundamental biological
characteristics/Anemia/Hemoglobinopathy/1
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
Hematology/Apply knowledge of fundamental biological characteristics/PNH/1

Answers to Questions 7–13

7. D The major Hgb in sickle cell trait is Hgb A, which constitutes 50% to 70% of the total.
Hgb S comprises 20% to 40%, and Hgb A2 and Hgb F are present in normal amounts.
8. B The structural mutation for Hgb S is the substitution of valine for glutamic acid at the
sixth position of the β-chain. Because glutamic acid is negatively charged, this
decreases its rate of migration toward the anode at pH 8.6.
9. D Substitution of a positively charged amino acid for a negatively charged amino acid in
Hgb C disease results in a slower electrophoretic mobility at pH 8.6.
10. C At pH 8.6, several Hgbs migrate together. These include Hgb A2, Hgb C, Hgb E, Hgb
0Arab, and Hgb CHarlem. These are located nearest the cathode at pH 8.6.
11. B Electrophoresis at alkaline pH usually shows 50% to 70% Hgb A, 20% to 40% Hgb S,
and normal levels of Hgb A2 in a patient with the sickle cell trait.
12. D Autosplenectomy occurs in sickle cell anemia as a result of repeated infarcts to the
spleen caused by an overwhelming sickling phenomenon.
13. A PNH is a rare acquired stem cell disorder that results in abnormalities of the RBC
membrane. This causes the RBCs to become highly sensitive to complement-mediated
 hemolysis. Because this is a stem cell disorder, abnormalities are seen in leukocytes
and PLTs, as well as in RBCs. PNH is characterized by recurrent, episodic
intravascular hemolysis, hemoglobinuria, and venous thrombosis.

14. Hemolytic uremic syndrome (HUS) is characterized by all of the following except:
A. Hemorrhage
B. Thrombocytopenia
C. Hemoglobinuria
D. Reticulocytopenia
Hematology/Correlate clinical and laboratory data/HUS/2
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
Hematology/Correlate clinical and laboratory tests/Special tests/2
16. Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?
A. Anti-I
B. Anti-i
C. Anti-M
D. Anti-P
Hematology/Apply knowledge of fundamental biological characteristics/Anemia/PCH/1
17. All of the following are associated with intravascular hemolysis except:
A. Methemoglobinemia
B. Hemoglobinuria
C. Hemoglobinemia
D. Decreased haptoglobin
Hematology/Correlate clinical and laboratory data/Anemia/Hemolytic/2
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
Hematology/Correlate clinical and laboratory data/Anemia/Hemolytic/2
19. “Bite cells” are usually seen in patients with:
A. Rh null trait
B. Chronic granulomatous disease
C. G6PD deficiency
D. PK deficiency
Hematology/Correlate clinical and laboratory data/RBC microscopic morphology/1

Answers to Questions 14–19

14. D Hemolytic anemia of HUS is associated with reticulocytosis. The anemia seen in
HUS is multifactorial, with characteristic thrombocytopenia, schistocytes, and
 polychromasia commensurate with the anemia.
15. D The autohemolysis test result is positive in G6PD and PK deficiencies and in HS but
is normal in PNH because lysis in PNH requires sucrose to enhance complement
binding. The addition of glucose, sucrose, or adenosine triphosphate (ATP) corrects
autohemolysis of HS. Autohemolysis of PK can be corrected by ATP.
16. D PCH is caused by the anti-P antibody, a cold autoantibody that binds to the patient’s
RBCs at low temperatures and fixes complement. In the classic Donath–Landsteiner
test, hemolysis is demonstrated in a sample placed at 4°C then warmed to 37°C.
17. A Methemoglobin occurs when iron is oxidized to the ferric state. Normally, iron is
predominantly in the ferrous state in the Hgb that circulates. During intravascular
hemolysis, the RBCs rupture, releasing Hgb directly into the bloodstream. Haptoglobin
is a protein that binds to free Hgb. The increased free Hgb in intravascular hemolysis
causes depletion of haptoglobin. As haptoglobin is depleted, unbound Hgb dimers
appear in the plasma (hemoglobinemia) and are filtered through the kidneys and
reabsorbed by the renal tubular cells. The renal tubular uptake capacity is
approximately 5 g/day of filtered Hgb. Beyond this level, free Hgb appears in urine
(hemoglobinuria). Hemoglobinuria is associated with hemoglobinemia.
18. B Spherocytes are characteristic of AIHA and cause increased osmotic fragility. In
AIHAs, production of autoantibodies against one’s own RBCs causes hemolysis or
phagocytic destruction of RBCs. A positive direct antiglobulin (DAT or Coombs’) test
identifies in vivo antibody-coated and complement-coated RBCs. A positive DAT
result distinguishes AIHA from other types of hemolytic anemia that produce
spherocytes.
19. C In patients with G6PD deficiency, the RBCs are unable to reduce nicotinamide
adenine dinucleotide phosphate (NADP); consequently, Hgb is denatured, and Heinz
bodies are formed. “Bite cells” appear in the peripheral circulation as a result of splenic
pitting of Heinz bodies.

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
Hematology/Correlate clinical and laboratory diseases/RBC microscopic morphology/1
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
Hematology/Apply knowledge of fundamental biological characteristics/Aplastic anemia/1
22. Congenital dyserythropoietic anemias (CDAs) are characterized by:
A. Bizarre multinucleated erythroblasts
B. Cytogenetic disorders
C. Megaloblastic erythropoiesis
 D. An elevated M:E ratio
Hematology/Apply knowledge of fundamental biological
characteristics/Anemia/Characteristics/2
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
Hematology/Correlate clinical and laboratory data/RBC microscopic morphology/Anemia/2
24. Which antibiotic(s) is (are) most often implicated in the development of aplastic
anemia?
A. Sulfonamides
B. Penicillin
C. Tetracycline
D. Chloramphenicol
Hematology/Correlate clinical and laboratory data/Aplastic anemia/1
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
Hematology/Apply knowledge of fundamental biological concepts/2

Answers to Questions 20–25

20. C RBC indices classify the anemia morphologically. Anemias can be classified
morphologically by using laboratory data; physiologically, based on the mechanism;
and clinically, based on an assessment of symptoms.
21. C Aplastic anemia has many causes, such as chemical, drug, or radiation poisoning;
congenital aplasia; and Fanconi syndrome. All result in depletion of hematopoietic
precursors of all cell lines, leading to peripheral blood pancytopenia.
22. A There are four classifications of CDAs, each characterized by ineffective
erythropoiesis, increased unconjugated bilirubin, and bizarre multinucleated erythroid
precursors.
23. D Microangiopathic hemolytic anemia is a condition resulting from shear stress to the
erythrocytes. Fibrin strands are laid down within the microcirculation, and RBCs
become fragmented as they contact fibrin through the circulation process, forming
schistocytes.
24. D Chloramphenicol is the drug most often implicated in acquired aplastic anemia.
About half the cases occur within 30 days after therapy, and about half are reversible.
Penicillin, tetracycline, and sulfonamides have been implicated in a small number of
cases.
25. A Sickle cell disorders are intracorpuscular RBC defects that are hereditary and result in
 defective Hgbs being produced. The gene for sickle cell can be inherited either
homozygously or heterozygously.

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
Hematology/Evaluate laboratory data to recognize health and disease states/Morphology/2
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
Hematology/Correlate lab data with clinical picture/Complete blood counts/3
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
Hematology/Correlate clinical laboratory data/Inclusions/1
29. Reticulocytosis usually indicates:
A. Response to inflammation
B. Neoplastic process
C. Aplastic anemia
D. RBC regeneration
Hematology/Correlate laboratory data for clinical conditions/Morphology/2
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
Hematology/Evaluate laboratory data to recognize health and disease states/Red cell
membrane/2

Answers to Questions 26–30

26. C Spherocytes are produced in AIHA. Spherocytes may be produced by one of three
mechanisms. First, they are a natural morphological phase of normal RBC senescence.
Second, they are produced when the cell surface:volume ratio is decreased, as seen in
HS. And, third, they may be produced as a result of antibody coating of RBCs. As the
 antibody-coated RBCs travel through the spleen, the antibodies and portions of the
RBC membrane are removed by macrophages. The membrane repairs itself; hence, the
RBC’s morphology changes from a biconcave disk to a spherocyte.
27. C This patient’s abnormal peripheral blood smear indicates marked RBC regeneration,
causing many reticulocytes to be released from bone marrow. Because reticulocytes
are larger than mature RBCs, MCV will be slightly elevated.
28. B As a result of splenectomy, Howell–Jolly bodies may be seen in great numbers. One
of the main functions of the spleen is pitting, which allows inclusions to be removed
from the RBC without destroying the cell membrane.
29. D Reticulocytes are polychromatophilic macrocytes, and the presence of reticulocytes
indicates RBC regeneration. Bone marrow’s appropriate response to anemia is to
deliver RBCs prematurely to the peripheral circulation. In this way, reticulocytes and
possibly NRBCs may be seen in the peripheral blood smear.
30. C HP is a membrane defect characterized by a spectrin abnormality and thermal
instability. MCV is decreased, and RBCs appear to be budding and fragmented.
 1.3
Hypochromic and Microcytic Anemias
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
Hematology/Correlate clinical and laboratory data/Microscopic morphology/Osmotic
fragility/1
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
Hematology/Correlate clinical and laboratory data/Anemia/Iron deficiency/2
3. IDA may be distinguished from anemia of chronic infection by:
A. Serum iron level
B. RBC morphology
C. RBC indices
D. TIBC
Hematology/Evaluate laboratory data to recognize health and disease states/Anemia/3
4. Which anemia has RBC morphology similar to that seen in IDA?
A. Sickle cell anemia
B. Thalassemia syndrome
C. Pernicious anemia
D. HS
Hematology/Correlate laboratory data with other laboratory data to assess test
results/Anemia/RBC microscopic morphology/2
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
Hematology/Evaluate laboratory data to recognize health and disease states/Anemia/Iron
deficiency/2
6. Storage iron is usually best determined by:
A. Serum transferrin levels
B. Hgb values
C. Myoglobin values
 D. Serum ferritin levels
Hematology/Apply knowledge of basic laboratory procedures/Iron/1

Answers to Questions 1–6

1. B Osmotic fragility is decreased because numerous target cells are present and have
increased surface volume in patients with thalassemia major.
2. C In IDA, there is an increase in TIBC and in RBC protoporphyrin. Serum iron and
ferritin levels are decreased. IDA is characterized by a microcytic hypochromic
anemia.
3. D In IDA, serum iron and ferritin levels are decreased, and TIBC and RBC
protoporphyrin are increased. In chronic disease, serum iron and TIBC are both
decreased because the iron is trapped in reticuloendothelial (RE) cells and is
unavailable to RBCs for Hgb production.
4. B Thalassemia and IDA are both classified as microcytic, hypochromic anemias. IDA is
caused by defective heme synthesis, whereas thalassemia is caused by decreased
globin chain synthesis.
5. A IDA is characterized by decreased plasma iron, increased TIBC, decreased %
saturation, and microcytic, hypochromic anemia. Iron deficiency occurs in three
phases: iron depletion, iron-deficient erythropoiesis, and IDA.
6. D Ferritin enters serum from all ferritin-producing tissues and, therefore, is considered a
good indicator of body storage iron. Because iron stores must be depleted before
anemia develops, low serum ferritin levels precede the fall in serum iron associated
with IDA.

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
Hematology/Evaluate laboratory data to recognize health and disease
states/Anemia/Sideroblastic/2
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
Hematology/Apply knowledge of fundamental biological
characteristics/Hemoglobinopathy/1
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
 Hematology/Correlate clinical and laboratory diseases/Hemoglobin/Hemoglobinopathy/2
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
Hematology/Evaluate laboratory data to recognize health and disease
states/Hemoglobinopathy/Characteristics/3
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
Hematology/Correlate laboratory results with disease states/2
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
Hematology/Correlate laboratory data to recognize health and disease states/2

Answers to Questions 7–12

7. D Sideroblastic anemias are a group of disorders characterized by hypochromic anemia,
ineffective erythropoiesis, an increase in serum and tissue iron, and the presence of
ringed sideroblasts in bone marrow.
8. C In thalassemia major, there is little or no production of the β-chain, resulting in
severely depressed or no synthesis of Hgb A. Severe anemia is seen, along with
skeletal abnormalities and marked splenomegaly. The patient is usually supported with
transfusion therapy.
9. D Patients with thalassemia major are unable to synthesize the β-chain; hence, little or no
Hgb A is produced. However, γ-chains continue to be synthesized and lead to variable
elevations of Hgb F in these patients.
10. C The indices will provide a morphological classification of this anemia. MCV is 75 fL
(reference range 80–100 fL), MCH is 20 pg (reference range 27–31 pg), and MCHC is
26.6% (reference range 32%–36%). Therefore, the anemia is microcytic hypochromic.
11. C Hgb A2 is part of the normal complement of adult Hgb. This Hgb is elevated in β-
thalassemia minor because the individual with this condition has only one normal β-
gene; consequently, there is a slight elevation of Hgb A2 and Hgb F.
12. B Thirty to fifty percent of the individuals with anemia of chronic inflammation
demonstrate a microcytic hypochromic blood picture, with decrease in serum iron.
Serum iron is decreased because it is unable to escape from the RE cells to be
delivered to the NRBCs in bone marrow.
 1.4
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
Hematology/Correlate clinical and laboratory data/Microscopic morphology/RBCs/2
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
Hematology/Evaluate laboratory data to recognize health and disease states/2
3. All of the following are characteristics of megaloblastic anemia except:
A. Pancytopenia
B. Elevated reticulocyte count
C. Hypersegmented neutrophils
D. Macrocytic erythrocyte indices
Hematology/Correlate clinical and laboratory data/Anemia/Megaloblastic/2
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
Hematology/Select course of action/Anemia/Therapy/3
5. Which of the following disorders is associated with ineffective erythropoiesis?
A. G6PD deficiency
B. Liver disease
C. Hgb C disease
D. Megaloblastic anemia
Hematology/Evaluate laboratory data to recognize health and disease states/RBC
physiology/2

Answers to Questions 1–5

1. D Megaloblastic anemia is macrocytic normochromic because there is no defect in Hgb
synthesis. These anemias comprise a group of asynchronized anemias characterized by
defective nuclear maturation resulting from defective DNA synthesis. This abnormality
 accounts for the megaloblastic features in bone marrow and macrocytosis in peripheral
blood.
2. D Pernicious anemia is caused by lack of intrinsic factor, which prevents vitamin B12
absorption.
3. B Megaloblastic anemias are associated with ineffective erythropoiesis and, therefore, a
decrease in the reticulocyte count.
4. B Administration of folic acid to a patient with vitamin B12 deficiency will correct the
hematological abnormalities, but the neurological problems will persist. This helps
confirm the correct diagnosis of vitamin B12 deficiency.
5. D Ineffective erythropoiesis is caused by destruction of erythroid precursor cells prior to
their release from bone marrow. Pernicious anemia results from defective DNA
synthesis; it is suggested that the asynchronous development of RBCs renders them
more prone to intramedullary destruction.

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)
Hematology/Correlate clinical and laboratory data/Anemias/2
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
Hematology/Apply principles of basic laboratory procedures/Microscopic morphology/2
8. The macrocytes typically seen in megaloblastic processes are:
A. Crescent shaped
B. Teardrop shaped
C. Oval shaped
D. Pencil shaped
Hematology/Apply principles of basic laboratory procedures/Microscopic
morphology/Differentials/2
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%
Hematology/Correlate clinical and laboratory data/Megaloblastic anemia/2
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
Hematology/Correlate clinical and laboratory data/Megaloblastic anemia/2

Answers to Questions 6–10

6. D Patients with pernicious anemia demonstrate pancytopenia with low WBC, PLT, and
RBC counts. Because this is a megaloblastic process and a DNA maturation defect, all
cell lines are affected. In bone marrow, this results in abnormally large precursor cells,
maturation asynchrony, hyperplasia of all cell lines, and a low M:E ratio.
7. B Patients with obstructive liver disease may have macrocytes on their peripheral blood
smear because of an increased tendency toward deposition of lipid on the surface of
RBCs. Consequently, the RBCs are larger or more macrocytic than normal RBCs.
8. C Macrocytes in true megaloblastic conditions are oval, as opposed to the round shape of
macrocytes usually seen in alcoholism and obstructive liver disease.
9. C The RBC indices in a patient with megaloblastic anemia are macrocytic and
normochromic. The macrocytosis is prominent, with MCV ranging from 100 to 130
fL.
10. B The patient will have increased MCV. One of the causes of a macrocytic anemia that
is not megaloblastic is increased reticulocyte count, here noted as increased
polychromasia. Reticulocytes are polychromatic macrocytes; therefore, MCV is
slightly increased.