PANGMALAKASANG REVIEW NI SIR JED

HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
1. Athanasius Kircher described erythrocytes as
A. Worms
B. Cork
C. Petite plaques Turgeon
D. RBC page 27

**rationale - Rodak’s (6TH Ed)

Athanasius Kircher in 1657, described erythrocytes as
“worms”
Anton van Leeuwenhoek in 1674 coined red blood cells
Giulio Bizzozero described platelets as petite plaques
Which between plasma and serum consumes
2. What is the diameter of red blood cells? fibrinogen?
A. 4 μm 5. In geriatric patients, when should the tourniquet be
B. 5 μm removed
C. 6 μm A. After the blood fills up the tube
D. 7 μm B. Before the blood fills up the tube
C. Before the needle is inserted
**rationale - Rodak’s (6th ed) D. After the needle is inserted
RBC Diameter = 7 - 8 μm
Central pallor = 1/3 **rationale - Turgeon
General appearance = disc-shaped, In order to reduce the risk of hematoma among
biconcave, anucleated geriatric patients, tourniquet should be removed right
before the needle insertion.
Ask Why does RBC have a central pallor?
yourself Do not leave the tourniquet for more than 1 minute
(rule of thumb) (Steininger - 2 mins); apply the
tourniquet 3-4 inches above the puncture site (Rodak’s
3. What is the anticoagulant to blood ratio in light blue
and Steininger)
top?
A. 1:9
6. Choose the correct order of draw in venipuncture
B. 9:1
A. Gray - Light Blue - Lavender - Red
C. 1:4
B. Light Blue - Lavender - Red - Gray
D. 4:1
C. Lavender - Light Blue - Red - Gray
D. Light Blue - Red - Lavender - Gray
**rationale - Linne and Ringsrud
If ang tanong ay anticoagulant to blood ratio, 1:9. If
**Rationale - CEU In House and Turgeon
blood to anticoagulant ratio, 9:1
Mnemonics : Stop Light Red, Stay Put, Green Light Go
Rodak’s = 0.105M - 0.109M/3.2% sodium citrate
Sterile Container - Microbiology
(Coagulation Studies)
Light Blue - Coagulation Studies (Hematology)
Red - Glass (no anticoagulant); Plastic (clot activator)
ESR?
Serum Separator Tube - Chemistry
Plasma Separator Tube - Chemistry
4. What do you the call straw colored fluid accumulated
Green (Heparin) - Flow cytometry, Blood Gas analysis
at the top of anticoagulated blood?
Lavender (EDTA) - Hematology
Gray (Sodium Fluoride) - Glucose analysis
A. Serum
B. Plasma
7. Evacuated tubes that are stored in low temperature
C. Fibrinogen
will yield what effect on draw volume?
D. Buffy Coat
A. Decrease
B. Increase
**rationale - Linne and Ringsrud
C. No effect
Clotted blood sample without anticoagulant = serum
D. Ignored
Anticoagulated blood sample = plasma
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
**Rationale - Turgeon complication shock, and cardiac arrest
Environmental factors that could affect evacuated Dermatologic Allergic reaction to antiseptics such as
tubes Complication iodine
 Temperature Anemia Iatrogenic anemia/nosocomial
 Light anemia/physician induced anemia
 Humidity Neurologic Diaphoresis, seizure, pain, or nerve
 Altitude complication damage
Low temperature = Decreased pressure in the tube =
decreased blood volume 10. Which of the following is not a characteristic of a
good blood smear?
8. Preferred puncture site for capillary puncture in
infants? A. Progression from thick (point of origin) to thin with
A. Lateral plantar surface of the heel uniform edge
B. 3rd or 4th finger of the palmar surface B. It does not touch the outer border of the slide
C. Median cubital vein of the antebcubital fossa C. It appears smooth without waves ofand gaps
D. Ear lobe D. It occupies 1/3 of the slide

**Rationale - Turgeon *rationale - Turgeon

Capillary Puncture Characteristics of good smear
Adults - 3rd or 4th finger of the palmar surface of the 1. It progresses from thick to thin
non-dominant hand 2. It does not touch the border of the slide
Infants (>1 yr old) - lateral plantar surface of the heel 3. It appears smooth, without waves and gaps
Infant Adult 4. It does not have any streaks, ridges, or troughs that
may indicate accumulation of leukocytes on that area
5. It is prepared with right amount of blood and spread
that will occupy 2/3 of the slide
Causes of a poor blood smear
1. Improper storage of anticoagulated blood which will
cause cellular distortion
2. Delay in processing
Puncture not deeper Puncture not deeper than 3. Dirty or poor quality slides
than 2.0 mm 2.4 mm
Ear Lobe = not preferred today (Duke's Test)
Median cubital vein = preferred venipuncture site
E. 3rd or 4th finger of the palmar surface = preferred
capillary puncture for adults

9. What is the most common phlebotomy complication?

A. Vascular complication
B. Infection
C. Cardiovascular complication
D. Dermatologic complication Steininger (page 25)

*rationale - Turgeon page 44 - 45

Vascular Bleeding and hematoma; most
Complication common complication
Uncommon vascular complication =
pseudoaneurysm, thrombosis, reflex
arteriospasm, arteriovenous fistula
Infection Cellulitis, phlebitis, sepsis, septic
arthritis, osteomyelitis
Cardiovascular Orthostatic hypotension, syncope,
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
**rationale - Steininger page 34
Cell Morphology in Properly Stained Smear
Erythrocytes Salmon pink
Platelets Purple-blue to lilac with
red granules
Eosinophils Distinct orange granules
Neutrophils Pinkish-tan cytoplasm

Monocytes Gray ground glass

appearance

Rodak’s 6th Ed (page 204) - Unacceptable blood smears

11. In smear preparation, the medical technologist

produced a thick smear. What could have possibly
happened in this situation?

A. Low angle of spreading

B. Small drop of blood
C. Blood is smeared slowly
D. High angle of spreading

**rationale - Steininger 13. Lymphocyte production begins in what fetal

Troubleshooting in Blood Smear hematopoietic stage?
Appearance Possible causes Solution A. Mesoblastic phase
Too thick smear 1. Large drop of  Drop of B. Hepatic phase
blood blood = C. Medullary phase
2. Slow 0.05 mL D. AOTA
spreading of (Steininger
blood ) **rationale - Rodak’s 6th ed.
3. High angle of  Calmly In hepatic phase, the spleen, kidney, thymus (first fully
spreading spread the developed organ in fetus), and lymph nodes are already
Too thin smear 1. Small drop of blood contributing to the fetal hematopoiesis.
blood using
2. Fast another Thymus = T cells; kidney and spleen = B cells
spreading of slide or
blood coverslip 14. Extramedullary hematopoiesis occurs in the
3. Low angle of  Proper following except
spreading angle = A. Iliac crest
45deg B. Liver
Gritty 1. Large number of leukocytes C. Spleen
appearance of may be seen on the edges D. Thymus
the feathered 2. Slow spreading of blood
tail 3. Dirty pusher slide/spreader **rationale - Rodak’s 6th Ed. Pages 44-45
4. Use of heparin Extramedullary means “outside the marrow or
12. Which is incorrectly matched among cells and their medulla”. Liver, spleen, and thymus are partakers of the
microscopic features upon proper staining? extramedullary hematopoiesis.
A. Erythrocytes:orange
B. Platelets:purple blue to lilac with red granules 15. Which growth factor is produced in the liver?
C. Eosinophils: orange granules A. EPO
D. Neutrophils: pinkish-tan cytoplasm B. TPO
C. G-CSF
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
D. KIT Ligand C. Cell size increases
D. Chromatin pattern becomes more loose
**Rationale - Rodak’s
Thrombopoietin/MPL ligand with IL-11 induce *rationale - Turgeon page 97
megakaryopoeisis. TPO is mainly produced by the Liver

16. Which of the following is not a fetal hemoglobin?

A. Gower-1
B. Gower-2
C. Portland-1
D. Portland-2

*rationale - Turgeon

19. Which of the following describes electric impedance?

A. It measures the cell interior complexity that causes
change in the radiofrequency signal
B. Uses tungsten-halogen lamp as light source
C. Measures nuclear to cytoplasm ratio
D. Measure the changes in electric resistance as the
cells pass through an aperture

*rationale - Rodak’s
17. Hematopoietic stem cells produce all lineages of
blood cells in sufficient quantities over the lifetime of
an individual because they:
A. Are unipotent
B. Have the ability of self-renewal by asymmetric
division
C. Are present in large numbers in the bone marrow
niches
D. Have a low mitotic potential in response to growth
factors

**rationale - Rodak’s
HSC has three fates: self-renewal, differentiation, or Electronic Impedance Detection and
apoptosis measurement changes in
electrical resistance
Symmetric division: both daughter cells will undergo produced by cells as they
differentiation (leaving the stem cell pool) traverse a small aperture.
Asymmetric division: one daughter cell will go back to Radiofrequency It may be used in
the stem cell pool (self-renewal) while the other conjunction to electric
daughter cell will undergo differentiation impedance

18. Which is true in cell maturity? It measures the cell

A. Nuclear-cytoplasmic ratio decreases as it matures interior complexity:
B. Cytoplasm becomes basophilic  Nuclear-to-cytoplasm

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
ratio
 Nuclear density
 Cytoplasmic
granulation
Optical Scatter Flow Cytometry
-As the cells pass through
the sensing zone and
interrupt beam, light is
scattered in all directions.

20. What does radiofrequency measure?

A. Nuclear-to-cytoplasmic ratio
B. Nuclear density
C. Cytoplasmic granulation
D. Cell size

**rationale - Rodak’s
Radiofrequency measures the following:
23. What are the parameters that are derived from RBC
 Nuclear-to-cytoplasm ratio
histogram?
 Nuclear density
A. MPV
 Cytoplasmic granulation
B. Hematocrit
C. RDW
21. What is flow cytometry’s principle
D. WBC count
A. Electric impedance
B. Optical scatter
**Rationale - KlubsyBear Tutorials
C. Radiofrequency
D. Oscillation Parameters that are WBC Count
directly obtained from RBC Count
**rationale - Rodak’s histogram Hemoglobin
Optical scatter = As the cells pass through the sensing Parameters that are MCV
zone and interrupt beam, light is scattered in all derived from RBC RDW
directions. histogram
Parameters that are MPV
22. Platelet clumps in hematology analyzers will not derived from platelet PDW
affect what parameter? histogram Platelet count
A. RBC Computed parameters Hematocrit
B. WBC MCH
C. Platelets MCHC
D. NOTA
24. What is the purpose of diluted acid solution in WBC
**rationale - Rodak’s manual counting?
Platelet clumps are large enough that when it passes
through the sensor of the hematology analyzer, these A. For uniformed counting of WBCs
clumps will yield to increase in WBC count and decrease B. To distinguish granulocytes to myelocytes
platelet count C. To lyse the RBCs
STUDY! D. NOTA

**rationale - Rodak’s 6th ed (Page 3)

The diluted acid will cause the RBCs to lyse so that
manual counting have lesser chance to be interfered.
In the spleen, old RBCs cannot withstand the acidic pH
environment that’s why they are being sequestered.

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
25. What is the area (mm2) of hemacytometer used for (↑anticoagulant)
counting platelets? Inclusion of buffy coat in Recent blood loss
A. 4 the reading
B. 1 Hematological Disorders Interstitial fluid inclusion
C. 0.4 → trapped plasma = sickle
D. 9 cell anemia, thalassemia,
macrocytic anemia,
**Rationale - Rodak’s hypochromic anemia,
spherocytosis
Dehydration

27. Which of the following hematologic tests may not

be a part of the usual CBC?
A. Platelet estimate
B. Reticulocyte count
C. Hemglobin
D. Hematocrit

**Rationale - Linne and Ringsrud

Complete Blood Count (CBC) consists primarily of the
Review! following
What is the formula for manual cell count?  Hemoglobin concentration
(write here)  Hematocrit concentration
 RBC count with morphology
 WBC count with differential
 Platelet estimate

Automated CBC = +RBC Indices

28. Modified Drabkin’s reagent contains all of the

following except
A. Potassium chloride
B. Potassium cyanide
C. Potassium ferricyanide
D. Dihydrogen potassium phosphate

**Rationale - Linne and Ringsrud and Rodak’s

Hemiglobincyanide (Cyanmethemoglobin) Method is
26. What will be the effect of dehydration in the used to measure hemoglobin by converting it to stable
hematocrit reading? cyanmethemoglobin in which it is meaured
A. Increase spectrophotometrically at 540 nm.
B. Decrease
C. Indeterminate 29. A medical technologist left the wintrobe tube on
D. NOTA the top of the refrigerator in a tilted position. What
could be the cause of increased ESR in the given
**Rationale - Rodak’s situation?
Hematocrit - It is the volume of packed RBC that A. Refrigerator top
occupies a given volume of whole blood B. Tilted angle of the tube
Increased Hematocrit Decreased Hematocrit C. Vibration
Insufficient centrifugation Improper sealing D. AOTA
Delayed reading Improper anticoagulant to
blood ratio **Rationale - Rodak’s 6th Ed. (page 168)

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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
High temperature (Refrigerator top), tilted ESR tube, Last stage with nucleolus - prorubricyte
and vibration may disturb the accuracy of the ESR Last stage with nucleus - metarubricyte (pyrenocyte =
leading to increased results. enveloped extruding nucleus)
READ THE TABLE IN RODAK’S! May lumalabas talaga Last stage of mitosis - rubricyte (murky-gray blue
doon! :) appearance)
First stage in which cytoplasm becomes pink - rubricyte
30. Odd one out
A. MCV: average number of RBC 34. Shift to the left of the oxygen dissociation curve
B. MCH: average weight of hemoglobin in an may occur in which of the following situations?
erythrocyte A. Increased 2,3-BPG
C. MCHC: average concentration of hemoglobin in each B. Increased temperature
individual RBC C. Increased pH
D. RDW: measures the anisocytosis D. Increased pCO2

**rationale - Linne and Ringsrud **Rationale - CEU In House and Klubsy Bear Tutorials
MCV = measures the average volume of RBC

31. What is the largest hematopoietic cell found in a

normal bone marrow aspirate?

A. Osteoblast
B. Myeloblast
C. Pronormoblast
D. Megakaryocyte

**Rationale - Rodak’s
Megakaryoctes are the largest cells in the bone marrow
and it can be observed under LPO.

32. What is the first morphologically identifiable RBC

precursor?
A. CFU-E
B. Pronormoblast
C. Orthochromic normoblast
D. Erythrocytes
35. Protrusion of enveloped nucleus is seen in what
**Rationale - Rodak’s stage?
BFU-E - CFU-E - Pronormoblast - Basophilic normoblast - A. Basophilic normoblast
Polychromatic Normoblast - Orthochromic Normoblast B. Polychromatic normoblast
- Reticulocyte - Erythrocyte C. Orthochromic normoblast
D. Reticulocytes
Progenitor - BFU-E and CFU-E
**rationale- Rodak’s
33. Which stage of erythrocyte maturation is the last
stage that will undergo cell division? Start of hemoglobin synthesis - prorubricyte
A. Basophilic normoblast Last stage of hemoglobin synthesis - reticulocytes
B. Polychromatic normoblast Last stage with nucleolus - prorubricyte
C. Orthochromic normoblast Last stage with nucleus - metarubricyte (pyrenocyte =
D. Reticulocytes enveloped extruding nucleus)
Last stage of mitosis - rubricyte (murky-gray blue
**rationale- Rodak’s appearance)
First stage in which cytoplasm becomes pink - rubricyte
Start of hemoglobin synthesis - prorubricyte
Last stage of hemoglobin synthesis - reticulocytes

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HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
C. 2 and 3
D. 2 and 4
**Rationale - Rodak’s

36. How can EPO increase the production of RBCs?

A. Decreases the intravascular hemolysis
B. Increasing the EPO receptors
C. Shift reticulocytes
D. Apoptosis of HSCs as they are no longer needed
39. Why does RBCs mostly rely on anaerobic glycolysis?
**rationale - Rodak’s A. They cannot convert carbohydrates to sugar
Erythropoietin (note: IT IS A TRUE HORMONE) has 3 B. RBCs cannot be exposed to ATP
major roles in order to increase the production of RBCs C. RBCs solely rely on CO2 exhange
1. Promoting the early release of reticulocytes (shift D. They don’t have mitochondria
reticulocytes)
2. Inhibition of HSC apoptosis **Rationale - Rodak’s
3. Decrease marrow transit time Once the cell is released from the bone marrow, the
cytoplasmic ribosomes and mitochondria will also be
37. Heinz bodies are: removed.
A. Readily identified with polychrome stains
B. Rarely found in G6PD deficient erythrocytes 40. What hexose-monophosphate shunt products
C. Closely associated with spherocytes participate in the detoxification of peroxides?
D. Denatured hemoglobin inclusions that are removed A. 2,3-BPG and pyruvic acid
by the spleen B. ATP and lactic acid
C. NADPH and reduced glutathione
*Rationale - Rodak’s D. Pyruvic and lactic acid

Letter B = Heinz Bodies
Letter A = ?
**Rationale - Rodak’s
HMP or pentose phosphate pathway diverts glucose-6-
phosphate to 6-phosphogluconate. The NADPH and
reduced glutathione prevents hemoglobin from
oxidative damage.

41. Hemoglobin iron may become oxidized to Fe3+ by

several pathologic mechanisms. What portion of the
Heinz bodies contain denatured hemoglobin on the RBC EMP reduces iron to Fe2+?
membrane.
A. HMP
G6PD deficiency is the most common inherited enzyme
deficiency worldwide. Due to the inability of the RBCs to B. Methemoglobin reductase pathway
resist oxidative stress (inability to detoxify peroxidase to non C. Rapoport-Luebering pathway
toxic substances), in return, the hemoglobin denatures on D. 2,3-BPG shunt
the RBC. The macrophages will bring these RBCs into spleen
and its inclusion will be pitted (bite cells) **Rationale - Rodak’s
HMP can prevent hemoglobin oxidation but not the
38. How many iron atom(s) and pyrolle rings, methemoglobin.
respectively, comprise the heme portion of the Methemoglobin Reductase pathway make use of
hemoglobin molecule? Cytochrome b5 reductase (methemoglobin reductase)
that serves as intermediate electron carrier (Fe3+ -
A. 1 and 3 Fe2+)
B. 1 and 4
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 PANGMALAKASANG REVIEW NI SIR JED
HEMATOLOGY RATIONALE
Prepared by: Louisse Nicole B. Manliclic, RMT
42. Where does heme biosynthesis occur?  Pancytopenia
A. Mitochondria and cytoplasm of BM erythroid  Reticulocytopenia
precursors  Hypocellular Bone Marrow
B. Mitochondria and cytoplasm of erythrocytes  Macrocytic RBCs
C. Nucleus of the BM erythroid precursors  Increased HbF
D. Golgi Apparatus of RBCs
45. All of the following are pathophysiology of bone
**Rationale - Rodak’s marrow failure except?
Heme biosynthesis starts in the erythroid precursors in A. Early apoptosis of HSC
the bone marrow (starts with Pronormoblast stage to B. Increased infiltration of normal cells
reticulocytes in the bone marrow), as the reticulocyte C. Loss of normal hematopoietic tissue
has been released, it will lose its mitochondria. D. Decreased production of hematopoietic growth
factors and hormones
43. It is the form of hemoglobin that normally
transports carbon dioxide from the tissues to the lungs **Rationale - Rodak’s
A. Carboxyhemoglobin Pathophysiology of Bone Marrow Failure may be of the
B. Methemoglobin following:
C. Oxyhemoglobin 1. Destruction of hematopoietic stem cells as results of
D. Reduced hemoglobin injury by drugs, chemicals, radiation, viruses, or
autoimmune mechanisms
**rationale - Linne and Ringsrud 2. Premature senescence and apoptosis of HSC due to
Reduced hemoglobin is different from genetic mutations
carboxyhemoglobin. Reduced hemoglobin means it is 3. Ineffective hematopoiesis caused by stem cell
reduced or has given of their oxygen molecule. mutations or Vitamin B12 or folate deficiency
Carboxyhemoglobin, on the other hand, contains 4. Disruption of the bone marrow microenvironment
carbon monoxide, that has 200x affinity to hemoglobin. that supports hematopoiesis
5. Decreased production of hematopoietic growth
44. A 6 year old patient has low blood cell count, factors or related hormones
reticulocytopenia, and hypocellular bone marrow. 6. Loss of normal hematopoeitic tissue as a result of
Consistent with these findings are hypopigmentation infiltration of the marrow space with abnormal cells
and scoliosis. The following clinical manifestations are
consistent with what disorder? 46. A 40 year old male patient has the following
A. Dyskeratosis congenita hematology results
B. Pernicious anemia
C. Fanconi Anemia MCV = 89 fL
D. Swachman-Bodian-Diamond Syndrome MCH = 28.7 pg
RBC Count = 3.50 x 1012/L
**Rationale - Rodak’s Hemoglobin = 13.9 g/dL
Fanconi Anemia is the most common inherited bone Hematocrit = 37%
marrow failure (autosomal recessive inheritance except Reticulocytes = 0.3%
mutation in FANCB gene) WBC Count = 2.4 x 103/μL
Clinical Manifestations of Fanconi Syndrome No immature cells are seen
 Physical Manifestations - may be visible upon birth
 Skeletal abnormalities = thumb malformations, Which of the following disorders are consistent with
radial hypoplasia, microcephaly, hip these findings?
dislocation, and scoliosis) A. Thalassemia
 Skin pigmentation = cafe au lait lesions, B. Aplastic Anemia
hypopigmentations, and hyperpigmentations C. Polycythemia vera
 Abnormalities of the eyes, kidneys, and D. Myelophthisic Anemia
genitalia
 Low birth weight and devlopment delay **Rationale - Steininger and Rodak’s
 Hematologic Abnormalities - may be visible on Thalassemia - microcytic, hypochromic anemia
childhood or adulthood Polycythemia vera - pancytosis
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HEMATOLOGY RATIONALE
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Myelopthisic Anemia - presence of blast cells
(leukoerythroblastosis)

47. A patient is seen with headache and ruddy

complexion. CBC shows elevated hemoglobin and
hematocrit, normal RBC morphology, leukocytosis, and
thrombocytosis. LAP is normal. EPO is decreased. What
is the diagnosis of the the patient?

A. Essential Thrombocythemia
B. Polycythemia vera
49. Which RBC inclusion is composed of denatured
C. Aplastic Anemia
hemoglobin?
D. Megaloblastic anemia
A. Basophilic stippling
B. Howell Jolly Bodies
**Rationale - Elsevier Medical Laboratory Science
C. Heinz Bodies
Review
D. Cabot Ring
Polycythemia Vera is a disorder caused by JAK2v V61F
mutation, which affects the cellular response to
**Rationale - Rodak’s
erythropoeitin.
Basophilic Precipitated
Lead poisoning
stippling RNA Thalassemia
Clinical Presentation Headaches
Hemoglibinopathies
Ruddy cyanosis
Megaloblastic
CBC ↑ Hgb, Hct
anemia
Pancytosis
Myelodysplastic
Laboratory Tests ↓EPO level syndromes
↑RBC Mass
Howell Jolly DNA/Nuclear Hyposplenism
N = LAP
Bodies fragment Postsplenectomy
Megaloblastic
48. Which poikilocyte is associated with anemia
abetalipoproteinemia? Hemolytic anemia
A. Spherocyte Thalassemia
B. Acanthocytes Myelodysplastic
C. Burr cells syndromes
D. Schistocytes Heinz Bodies Denatured G6PD Deficiency
hemoglobin Unstable
**rationale - Rodak’s hemoglobin
Oxidant
drugs/chemicals
Cabot Ring Blue rings or Megaloblastic
figure-eights anemia
Myelodysplastic
syndromes

50. Which of the following disease could yield into this

type of blood picture

Acanthocyte (spurr cell) = few, irregular spaced projections

varying length
Echinocyte (burr cell) = RBC with blunt or pointed, short
projection that are usually evenly spaced over the surface of
the cell A. Liver Disease
B. Bone Marrow Failure
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HEMATOLOGY RATIONALE
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C. IDA count, and platelet count
D. Megaloblastic Anemia Reticulocyte count = It measures the ability of the bone
marrow to increase RBC production in response to
**Rationale - Rodak’s and Steininger
anemia
Liver Disease Target cell or codocytes
PBS = It is the examination of morphological
Acanthocytes (severe liver
disease) characteristics of the blood cells and visualization of
Bone Marrow Failure Macrocyte some values indicated from CBC
IDA Elliptocyte, ovalocyte,
microcytes 54. Which stage of IDA is characterized with the
Megaloblastic Anemia Oval macrocyte following:
Decreased serum iron and ferritin
51. Anemia is functionally defined by: Increased TIBC and FEP
A. Decrease in RBC count Normal RBC indices
B. Decrease in hemoglobin concentration
C. Hematocrit below reference interval A. Stage 1
D. Insufficiency in oxygen carrying capacity B. Stage 2
C. Stage 3
**Rationale - Rodak’s (6th Ed) D. Uncommon and IDA should be ruled out
Anemia is not a disorder but a complication of a certain
disorder **Rationale - Rodak’s
Functional definition = Anemia is the decrease of
oxygen-carrying capacity
Operational definition = decrease in hemoglobin
content of blood caused by reduction of RBC count,
hemoglobin concentration, and hematocrit by 10% of
reference interval

52. Which of the following could cause relative anemia?

I. Pregnancy
II. IV Fluid administration
III. Renal Failure
IV. Hypoproteinemia

A. 1 and 2
B. 1 and 4
C. 2 and 3 In stage 2, there’s already maximum usage of stored iron
(Ferritin) therefore, erythrocytes tend to be released without
D. 3 and 4
iron (Free Erythrocyte Protoporphyrin).
TIBC or Total Iron Binding Capacity is an indirect
**Rationale - Steininger measurement of transferrin. If it is increased, it means that,
Pregnancy, IV fluid, and hyperproteinemia will yield to there is low iron that has been saturated with transferrin.
relative anemia since it will increase the plasma volume Ferritin = stored iron
IDA = most common cause of microcytic anemia
53. What are the initial laboratory tests performed for
the diagnosis of anemia 55. Anemia of chronic inflammation is characterized
A. CBC, reticulocyte count, and PBS with
B. Reticulocyte count, serum iron, vit B12 deficiency, A. Decreased iron storage in reticuoloendothelial
and folate assays system
C. BM study, iron studies, and PBS B. Macrocytic erythrocytes
D. CBC, iron studies, and reticulocyte count C. Increased TIBC
D. Decreased serum iron levels
**Rationale - Rodak’s
CBC = RBC count, Hgb conc, Hct, RBC indices, WBC **Rationale - Rodak’s

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derive the probable type of anemia.

MCV = Hct x 10 / RBC Count

MCV = 25.5 x 10 / 1.97
MCV = 129.44 (Macrocytic)
Hemolytic Anemia - normocytic
IDA - Microcytic
Aplastic Anemia - Macrocytic,non-megaloblastic or
normocytic
Megaloblastic Anemia - Macrocyticm megaloblastic

57. In the pathogenesis of of the anemia of chronic

There is a decrease in serum iron level as ferritin, that stores
inflammation, hepcidin levels
iron is also an Acute Phase Reactant. Hence, when
inflammation is observed, ferritin ought to store the iron in A. Increase during inflammation and reduce iron
the body causing the low serum iron level. absorption from enterocytes
B. Increase during inflammation and increase iron
56. A 65 year old woman consulted the clinic as she absorption from enterocytes
complains of intense fatigue, difficulty in breathing, and C. Decrease during inflammation and reduce iron
a sore tongue. Below is the following laboratory results absorption from enterocytes
D. Decrease during inflammation and increase iron
Hemoglobin: 8.7 g/dL absorption from entercoytes
Hematocrit: 25.5%
WBC count: 4.0 × 109/L **Rationale - Rodak’s
WBC Differential Count Hepcidin is a hormone that is produced by the
Neutrophils: 65% hepatocytes to regulate the iron absorption in the
Lymphocytes: 31% intestine and release the iron from macrophages and
Monocytes: 4% hepatocytes. It is also an acute phase reactant
RBC Count: 1.97 × 1012/L therefore it increases during inflammation.
RDW: 19%
Platlet count: 134 × 109/L 58. Screening tests for megaloblastic anemia includes
Reticulocyte count: 0.3% which of the following?
I. CBC
What is the probable type of anemia seen in the patient? II. Reticulocyte Count
A. Hemolytic anemia III. Iron Studies
B. Iron Deficiency Anemia IV. LDH
C. Aplastic anemia
D. Megaloblastic anemia A. AOTA
B. I, II, III
**Rationale - Rodak’s C. I, II, IV
RBC Indices Formula Normal Value D. II, III, IV
MCV - ave. MCV = Hct × 80 - 100 fL
volume of RBC 10/RBC count **Rationale - Rodak’s (Page 290)
MCH - ave. MCH = Hgb × 26 - 32 pg Screening tests for Megaloblastic Anemia
weight of 10/RBC count 1. CBC -
hemoglobin of  ↓ hemoglobin and hematocrit
RBC  Pancytopenia
MCHC - ave. MCHC = Hgb × 32 - 36 g/dL  Reticulocytopenia
Concentration of 100/Hct  MCV = 100 - 150 fL
hemoglobin in 2. Reticulocyte Count = low
each individual 3. WBC manual differential count = hypersegmentation
RBC of neutrophils (pathognomoniic)
By examination of blood film and RBC indices, you can 4. Serum Bilirubin and LDH = hemolytic anemia
 RBCs contain high level of LDH
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59. The mutation seen in sickle cell anemia is: **Rationale - Rodak’s
A. β6Glu→Val Sickle Cell Disease is a hemoglobinopathy characterized
B. β6Glu→Lys by the replacement of glutamic acid to valine at the 6 th
C. β26Glu→Lys position of the globin chain. Since Hemoglobin F still do
D. β63Glu→Arg not contain beta chains, there will be no replacement
that will happen yet.
**Rationale - Elsevier Medical Laboratory Science
Review 63. RBC morphological characteristics of a patient with
β6Glu→Val Sickle cell anemia Beta-Thalassemia major
β 6Glu→Lys
Hemoglobin C A. Macrocytes, acanthocytes, target cells,
β26Glu→Lys Hemoglobin E polychromasia, NRBCs
β 63Glu→Arg
Hemoglobin Zurich B. Macrocytes, hypochromia, target cells, RBC
inclusions, NRBCs
60. Thalassemia is characterized by C. Microcytes, hypochromia, target cells, sickle cells,
A. Absence of Fe2+ in hemoglobin elliptocytes
B. Decreased rate of heme synthesis D. Microcytes, hypochromia, target cells, RBC
C. Decreased rate of globin synthesis inclusions, and NRBCs
D. Structural abnormalities in the hemoglobin synthesis
**Rationale - Rodak’s
**Rationale - Rodak’s and CDC Beta-Thalassemia major shows RBC morphology:
Thalassemia is first described by Cooley and Lee in 1925  Microcytic (MCV = 50 - 70 fL), hypchormic RBCs
when they observed four children with anemia, mild (MCH = 12 - 20 pg)
hepatomegaly, splenomegaly, and mongoloid faces  Anisocytosis
Thalassemia is a type of quantitative abnormality of the  Poikilocytosis = target cells, teardrop cells, and
heme molecule characterized with absence or elliptocytes
reduction of globin chains in the heme molecule  RBC Inclusions = basophilic stippling, Howell-Jolly
Bodies, and Pappenheimer bodies
61. In hemoglobin solubility test, saponin serves as
A. Reducing agent 64. The primary function of leukocytic system
B. Lysing agent A. Antibody synthesis
C. Buffer B. Immunity against disease
D. Fixative? C. To protect against allergic reactions
D. Enzyme production
**Rationale - Rodak’s
Hemoglobin solubility test is the most common **Rationale - Turgeon
screening test for Hb S. The leukocytic system is designed in order to protect
 Saponin - lysing agent our body from pathogens. Every cell in the myelocytic
 Buffered sodium hydrosulfite (Dithionite) - and lymphocytic lineage has designated functions
reducing agent (protection, antibody synthesis, enzyme release from
Blood - lysed (disruption of membrane will release granules, etc.).
hemoglobin) - reduction of ferrous to ferric oxidation
state - polymerization of Hb S - turbidity (+) 65. What is the unit of measurement for white cell
count
62. Patients with sickle cell disease usually do not A. Cells × 1012 per liter
exhibit symptoms until 6 months of age due to the fact B. Cells × 109 per liter
that: C. %
D. g/dL
A. Hemoglobin levels are higher upon birth
B. Immune level is still effective to protect the infant **Rationale - Linne and Ringsrud
C. The mother’s blood could still protect the infant WBC = Cells × 109 per liter
D. HbF level is still high RBC Count = Cells × 1012 per liter

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Hematocrit = % Eosinophils
Hemoglobin = g/dL  Immune regulation
 APC
 Regulate mast cell function
66. Interleukin specific for Eosinophil differentiation?  Destroys tissue-invading helminthes
A. IL-5 Basophils - “poor relatives” of mast cells and basophils
B. IL-2 since it also has IgE receptor.
C. IL-6  Initiators of allergic inflammation (IgE)
D. IL-9  Induce B cells to synthesize IgE
Monocyte
**Rationale - Rodak’s  Macrophage = tissues
Eosinophils = IL-5, IL-3, GM-CSF  Innate Immunity (non-specific phagocytosis) and
Cytokine Target cells Adaptive Immunity (APCs) functions
IL-6 T cells  Removal of debris and dead cells
B cells
Liver 69. What is the largest WBC found in a normal
IL-2 T cells peripheral blood?
NK cells
B cells A. Neutrophil
Monocytes B. Lymphocyte
C. Eosinophil
IL-9 No application in
D. Monocyte
Hematology
**Rationale - Steininger and Ciulla
67. A manual WBC count is performed. 80 WBCs are
Neutrophil 10 - 15 μm
counted in the four large corner squares of Neubauer
chamber. Dilution is 1:100. What is the total WBC count? Lymphocyte Small lymphocyte = 6 - 8
μm
A. 4.0 × 109/L Medium to Large
B. 8.0 × 109/L Lymphocyte = 8 - 12 μm
C. 12.0 × 109/L Eosinophil 12 - 17 μm
D. 20.0 × 109/L Monocyte 12 - 20 μm

**Rationale - Harr and Rodak’s 70. Which are considered as tissue basophils associated
Formula for Manual Cell Count with allergic reactions?
𝐜𝐞𝐥𝐥𝐬 𝐜𝐨𝐮𝐧𝐭𝐞𝐝 × 𝐝𝐢𝐥𝐮𝐭𝐢𝐨𝐧 𝐟𝐚𝐜𝐭𝐨𝐫
𝐓𝐨𝐭𝐚𝐥 𝐂𝐞𝐥𝐥 𝐂𝐨𝐮𝐧𝐭 =
𝐚𝐫𝐞𝐚 (𝐦𝐦𝟐 ) × 𝐝𝐞𝐩𝐭𝐡 A. Basophil
B. Dendritic cell
80 × 100 C. Macrophages
Total Cell Count =
4 × 0.1 D. Mast cells
=20,000/μL or 20.0 × 109/L

**Rationale - Rodak’s
68. Which of the following white blood cell
Mast Cells
nonspecifically destroys foreign organisms?
 Not considered as as part of white blood cells
A. Eosinophils
 Function
B. Neutrophils
 tissue effector cells of allergic responses and
C. Basophils
inflammatory reaction (release of lipid
D. Monocytes
mediators, proteases, proteoglycans,
cytokines)
**Rationale - Rodak’s
 APCs = presents pathogens to ______
Neutrophil/Segmenters
 Part of innate immune system
71. Which maturation stage of myelocytic lineage
 Function: destruction of foreign organisms that is
develops a kidney shaped-nucleus?
not antigen specific; PHAGOCYTOSIS
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A. Myeloblast
B. Promyelocyte **Rationale - Rodak’s
C. Myelocyte NEUTROPHIL GRANULES
D. Metamyelocyte PRIMARY (AZUROPHILIC) GRANULES
Stage of formation: Promyelocyte Stage
**Rationale -Turgeon Mnemonic =
Primary na dapat gawin sa boards: “PDE CALM?”
Proteinase-3
Defensins
Elastase
Cathepsins
Myeloblast Size : 10-18μm Acid-β-glycerophosphate
Nucleus: Oval/Round Lysozyme
Cytoplasm: basophilic cytoplasm that Myeloperoxidase
lacks granules SECONDARY (SPECIFIC) GRANULES
 Auer Rods = aggregates of fused Stage of Formation: Myelocyte and Metamyelocyte
lysosomes (pathologic) Mnemonic: “BGC LNG TOL?”
Promyelocyte Size: 14-20 μm β2-microglobulin
Nucleus: Oval/Round Gelatinase
Cytoplasm: primary, heavy granulation,
Collagenase
moderate blue
Lysozyme
Myelocyte Size: 12 - 18 μm
Neutrophil-Gelatinase-associated lipocalin
Nucleus: Oval/Round
Cytoplasm: secondary/specific granules Transcobalamin I
Metamyelocyte Size: 10-18μm Others
Nucleus: Indented, “kidney-shaped” Lactoferrin
Cytoplasm: Pink, with specific (secondary TERTIARY (GELATINASE) GRANULES
and tertiary) granules Stage of Formation: Metamyelocyte and Band Stages
Band Size: 10 - 16 μm Mnemonics: para di mapagalitan sa lab, dapat lagi tumitingin
Nucleus: Elongated, curved, “horseshoe” sa “TERTIARY GC LAB”
Cytoplasm: Pinkish (Tertiary and Gelatinase
Secretory granules) Collagenase
Lysozyme
72. What percentage of neutrophils in the peripheral Acetyltransferase
blood constitutes the circulating pool? β2-microglobulin
SECRETORY GRANULES/SECRETORY VESICLES
A. 100% Stage of Formation: band/segmented
B. 80% CD11b/CD18 = for binding of neutrophil to endothelial cells
C. 50% Vesicle Associated Membrane 2
D. 30% CD10, CD 13, CD14, CD16
Cytochrome b558
**Rationale - Ciulla Complement 1q receptor
Alkaline phosphatase - only WBC with ALP
Circulating pool 50%
Complement receptor
(peripheral blood)
Marginal pool (walls of the 50% 74. All of the following are characteristics of a leukemoid
vessels) reaction except:
A. Platelet count: normal
73. Which of the following is contained in the primary B. Hemoglobin: Normal
granules of the neutrophil? C. Neutrophil Morphology: toxic granulation
D. Eosinophil and Basophil: often elevated
A. Myeloperoxidase **Rationale - Rodak’s
B. Histamine
C. ALP
D. Lactoferrin
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78. A patient with asthma passed a sputum sample. In the
sputum sample, there’s a crystalline structure that appears as
“double pyramids”.

A. Charcot-Leyden Crystals
B. Washington DC Crystals
C. Hb SC crystals
D. Hematoidin crystals

**Rationale - Rodak’s
Charcot-Leyden Crystals - protein in the primary granules of
eosinophilic promyelocytes
75. Type II Myeloblasts are characterized by:
*Charcot-Leyden Crystals may be seen in the following
A. Basophilic cytoplasm with many secondary granules samples: sputum, tissues, and stool
B. Absence of granules
C. Presence of fewer than 20 primary granules per cell
79. Which of the following is considered as the
D. The presence of folded nucleus
pathognomonic in Hodgekin’s Disease
**Rationale - Rodak’s
A. Flame cells
Myeloblast Stage and its B. Reed-Sternberg cells
Types C. Niemann-Pick Cells
Type I Myeloblast - no visible D. Reactive lymphocytes
granules when observed
under light microscope with **Rationale - Harr (Medical Laboratory Science Review);
Romanowsky stain Rodak’s; Turgeon
Type II Myeloblast = Reed-Sternberg cells Owl’s eye appearance
presence of fewer than 20
dispersed primary granules
Type II Myeloblast (Rodak’s) Type III Myeloblast =
presence of more than 20
primary granules.
Niemann-Pick Disease
76. A phenomenon in which there is an increase of young
white blood cells

A. Shift to the left

B. Shift to the right Flame cells - Plasma cells with distinct
C. Pelger Huet Anomaly red cytoplasm
D. Leukocytopenia - Contains increased
quantities of glycogen or
**Rationale - Rodak’s other intracellular deposits
Young WBCs are not usually seen in peripheral flood film. Reactive Lymphocyte

Left Shift/Shift to the Left - the phenomenon where there is

an increased number of bands or younger than bands in the
peripheral blood

77. Which is true in viral infections? 80. Rieder’s cells are associated with
A. Decreased neutrophils
B. Decreased lymphocytes A. Chronic Lymphocytic Leukemia
C. Increased eosinophils B. Niemann-Pick Disease and Burkitt’s Lymphoma
D. Decreased eosinophils C. Leukosarcoma
D. Natural artifact
**Rationale - Rodak’s
Possible findings in viral infections = lymphocytosis and **Rationale - Turgeon
neutropenia. Rieder’s cells are normal lymphocytes however their nucleus
is notched, lobulated, and clover-leaf like. It can be seen in
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CLL but also in improper smear preparation.  Cells affected exhibit
large lysosomes that are
81. This nonmalignant leukocyte disorder is characterized as dysfunctional
the lack of inability for neutrophils and monocytes to roll
from the circulation to the site of inflammation 83. Multiple myeloma is most difficult to distinguish from?
A. Benign Adenoma
A. Chediak-Higashi Syndrome B. Benign monoclonal gammopathy
B. Wiskott-Aldrich Syndrome C. Acute Myelogenous Leukemia
C. Leukocyte Adhesion Disorder D. CLL
D. CGD
**Rationale - Harr and Rodak’s
**Rationale - Rodak’s and Turgeon Diagnostic Criteria for Plasma Cell Neoplasms
Diapedesis - It is the movement of immune cell from the Monoclonal Benign Serum Monoclonal
circulating pool to the peripheral tissue Gammopathy of monoclonal Protein (non-IgM) <
Undetermined proliferation of 3 g/dL
Leukocyte Adhesion Disorder is an rare inherited disorder Significance plasma cells
due to gene mutation that causes the leukocytes not to stick Absence of end
on the endothelial cells during their migration. organ damage
 Reccurent severe bacterial and infection  Hypercalcemia
 Treatment: HSC transplant  Renal
insufficiency
82. Which of the following disorders are associated with  Anemia
abnormal functionality of WBC?  Bone lesions
I. Lazy Leukocyte Syndrome Multiple Clonal bone marrow plasma cells
II. CGD Myeloma/Plasma greater than 10% or Biopsy-proven
III. Job’s Syndrome Cell Myeloma extramedullary plasmacytoma
IV. Chediak-Higashi Syndrome
Any one of myeloma defining
A. I, II events (end organ damage):
B. I, II, III  • Hypercalcemia
C. II, III, IV  • Renal insufficiency
D. AOTA  • Anemia
 • Bone lesions (skeletal
**Rationale - Rodak’s, Turgeon, Steininger, Klubsy Bear survey/CT/ PET-CT)
Tutorials
Lazy Leukocyte Syndrome Abnormal neutrophil random Clonal bone marrow plasma
(chemokinesis) and directed cells >60% or Involved/Uninvolved
(chemotaxis) migration serum FLC ratio >100 (when involved
CGD It is a disorder characterized FLC >100 mg/L) or >1 focal lesion on
as the inability of the MRI
neutrophils to undergo
respiratory burst after 84. Which of the following is not a lysosomal storage disease?
phagocytosis A. Sanfilippo Syndrome
Job’s Syndrome A disorder characterized by B. Niemann-Pick Disease
the inability of the C. Pelger-Huet Anomaly
neutrophils to move during D. Gaucher disease
chemotaxis, but random
movement is normal. *Rationale - Rodak’s
Sanfilippo Syndrome A mucopolysaccharidoses
 High IgE disorder characterized by
 Cold staphylococcal deficiency of the enzyme
abscess heparan sulfatase
Chediak-Higashi Syndrome Mutation in CHS1 LYST gene Niemann-Pick Disease It is characterized by an
which encodes for a protein accumulation of fat in
that regulates the cellular lysosomes of vital
morphology and function of organs
lysosomal-related organelles  Foam Cells - cytoplasm

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packed with lipid-filled  Morphology
lysosomes  Cytochemistry
 Sea Blue Histiocytes -  Immunophenotype
macrophages with  Genetics
lipofucsin,
glycophospholipid, and 87. What is the solid tumor counterpart of monocytic
sphingomyelin leukemia?
contained in
cytoplasmic granules A. Myeloma
Gaucher Disease Autosomal recessive disorder B. Lymphoma, undifferentiated
characterized with defect or C. Chloroma
deficiency in β- D. Reticulum cell sarcoma
glucocerebrosidase enzyme
**Rationale - Turgeon
 Gaucher Cells
(Macrophages) -
abundant fibrillar blue-
gray cytoplasm with a
striated or wrinkled
appearance (onion skin-
like)
Pelger-Huet Anomaly Autosomal dominant
disorder characterized by
decreased nuclear
segmentation and distinctive 88. AML findings may include
coarse chromatin clumping A. Increase RBC mass, leukocytosis, thrombocytosis, and
bleeding
B. Decreased RBC mass, leukocytosis, thrombocytopenia, and
85. What leukocyte cytoplasmic inclusion is composed of
splenogemaly
ribosomal RNA?
C. Anemia, leukoctopenia, hyperuricemia,
thrombocytopenia, neutropenia
A. Primary granules
D. Anemia, leukoctopenia, thrombocytopoiesis,
B. Toxic granules
hypersplenectomy
C. Howell-Jolly bodies
D. Dohle Bodies
Acute Myelogenous Leukemia - It is the most common type
of leukemia in adults
**Rationale - Rodak’s
Dohle Bodies - cytoplasmic inclusions consisting of remnants
Clinical presentation
of RNA arranged in parallel rows.
 WBC Count = 5 - 30 × 109/L
May Hegglin Anomaly - It is caused by mutation in MYH9
 PBS = myeloblasts
gene; large Dohle-like granules composed of precipitated
 CBC = anemia
myosin heavy chains
 Laboratory results = hyperuricemia,
 Thrombocytopenia and giant platelets
hyperphosphatemia, and hypocalcemia (page 543,
Rodak’s)
86. FAB Classification does not include:
A. 30% blast cells
89. In immunophenotyping of T-ALL, which of the following
B. Morphological characteristics
CD markers may be present?
C. Cytochemical staining
A. CD19
D. Molecular biology
B. CD22
C. CD2
**Rationale - Turgeon
D. CD21
French American British  30% blast cells (BM and
Classification PB) **Rationale - Rodak’s
 Morphological
characteristics - Wright
stain and Cytochemical
stains
World Health Organization  20% blast cells

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A. Macrocytic, normochromic
B. Normocytic, normochromic
C. Microcytic, hypochromic
D. Microcytic, hyperchromic

**Rationale - Harr
There’s no abnormality in the RBC production, therefore, the
erythrocytes released are still normal
90. Leukocytes that demonstrate positive in the tartrate
resistant acid phosphatase cytochemical stain are seen in
94. What is the M:E ratio of a patient with leukemia?
what condition?
A. 2:1
B. 4:1
A. Infectious lymphocytosis
C. 8:1
B. T-ALL
D. 10:1
C. Malignant lymphoma
D. Hairy cell leukemia
**Rationale - Harr
There is an increase or infiltration of the myeloid cell lineage
**Rationale - Klubsy Bear Tutorials,
in the bone marrow than erythroid lineage leading therof to
the overpowering of the latter population.

95. Blasts of monocytic predominate in what AML?

A. FAB M2
B. FAB M3
C. FAB M4
D. FAB M5

**Rationale - Turgeon

91. Which of the following statements are true about non-

Hodgekin’s Lymphoma?

A. Lymphadenopathy is the most common presenting

syndrome
B. Initially systemic disease rather than localized tumor
C. Proliferation of malignant cells primarily involving the
bone marrow
D. Often associated with multiple bone lesions

**Rationale - Steininger and Ciulla 96. A patient exhibiting anemia, thrombocytopenia, and
Painless and enlarged lymph nodes are the most common neutropenia. Laboratory result shows
presentation of NHL.
Specific esterase = +
92. Which of the following is increased in Waldenstrom’s Non-specific esterase = +
Macroglobulinemia Presence of 35% blast cells that consist mainly of monoblast
and myeloblast
A. IgE
B. IgD A. M3
C. IgG B. M4
D. IgM C. M5
D. None of the above
**Rationale - Turgeon
Waldenstrom’s Macroglobulinemia - B cell neoplasm by 97. Which reaction pattern represents myelomonocytic
lymphoproliferative disorder with infiltration of the bone leukemia?
marrow with IgM
A.
93. Which type of anemia is present in a patient with acute SB MPO PAS NASDCA NA ACP
leukemia? + + - - - -
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B. B. Not predictive
SB MPO PAS NASDCA NA ACP C. Good prognosis if Philadelphia Chromosome is present
+ + - + - - D. Worse prognosis if Philadelphia Chromosome is present
C.
SB MPO PAS NASDCA NA ACP **Rationale - Harr
+/- +/- - +/- ++ - Philadelphia chromosome appear in 90% of patients with
D. CML
SB MPO PAS NASDCA NA ACP Some study shows that, patients with ALL that has this
+/- +/- + - + - chromosome has poorer prognosis
What is Philadelphia Chromosome?
**Rationale - Turgeon
100. Which of the following is often associated with CML but
not with AML?

A. Hemorrhage
B. WBCs greater than 20.0 × 109/L
C. Infections
D. Splenomegaly

98. A 24-year-old man with Down Syndrome presents fever, **Rationale - Harr and Rodak’s
pallor, lymphadenopathy, and hepatosplenomegaly. His CBC Splenomegaly is seen in more than 90% of patients with CML
results are as follows: CML Clinical Features
 Frequent infection
WBCs = 10.8 × 109/L  Anemia
Segmenters = 0.08%  Bleeding
Lymphocytes = 0.25%  Splenomegaly
PAS (+) Blasts = 67%  Neutrophilia; Basophilia; Eosinophilia
 Thrombocytosis
RBCs = 1.56 × 1012/L
Hgb = 3.3 g/dL
Hct = 11%
Platelets = 2.5 × 109/L
These findings are suggestive of:

A. Myeloproliferative disrder
B. Leukomoid reaction
C. ALL
D. Hodgekin’s lymphoma

**Rationale - Harr and Rodak’s

Clinical Manifestations in ALL

 Hepatomegaly
 Lypmhadenopathy
 Fever
 Organomegaly
 Bone pain

99. In CML, findings with Philadelphia chromosome is

indicative of?

A. CML may transform into AML

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