Laboratory Techniques in Hematology
1.
A 25-year-old woman presents with fatigue and pallor. Her CBC shows microcytic
anemia. Which laboratory technique differentiates between iron deficiency anemia
and thalassemia trait?
A. Hemoglobin electrophoresis
B. Osmotic fragility test
C. Bone marrow biopsy
D. Reticulocyte count
Answer: A. Hemoglobin electrophoresis
Explanation: Hemoglobin electrophoresis detects abnormal hemoglobin patterns seen
in thalassemia and helps distinguish it from iron deficiency anemia, which lacks such
changes.
2.
A 50-year-old man has easy bruising and bleeding. Peripheral smear shows normal
platelets. Which laboratory test confirms functional platelet defects?
A. Platelet aggregation studies
B. Bleeding time
C. Coagulation factor assay
D. Prothrombin time (PT)
Answer: A. Platelet aggregation studies
Explanation: These studies assess the ability of platelets to aggregate in response to
specific agonists, which is essential in diagnosing qualitative platelet disorders.
3.
A patient with chronic lymphocytic leukemia (CLL) requires flow cytometry. Which
marker is characteristic for CLL?
A. CD19
B. CD20
C. CD5
D. CD10
Answer: C. CD5
Explanation: CLL typically exhibits co-expression of CD5 (a T-cell antigen) and B-cell
markers, aiding in diagnosis.
4.
Which method is most sensitive for detecting minimal residual disease in acute
leukemia?
A. Light microscopy
B. Cytogenetic analysis
C. PCR for fusion gene transcripts
D. Immunohistochemistry
Answer: C. PCR for fusion gene transcripts
Explanation: PCR can detect specific genetic rearrangements at very low levels, making
it highly sensitive for MRD.
5.
A 30-year-old developed jaundice after starting antimalarials. Which test confirms
hereditary spherocytosis as the cause of his hemolysis?
A. Osmotic fragility test
B. Serum bilirubin
C. Hemoglobin electrophoresis
D. haptoglobin assay
Answer: A. Osmotic fragility test
Explanation: Increased fragility is seen in hereditary spherocytosis due to membrane
defects.
6.
To differentiate between DIC and TTP, which laboratory finding favors DIC?
A. Normal platelet count
B. Increased D-dimer
C. Normal PT and aPTT
D. Presence of schistocytes without decreased fibrinogen
Answer: B. Increased D-dimer
Explanation: DIC features elevated D-dimer due to fibrinolysis and consumption of
clotting factors.
7.
A 17-year-old with fever and sore throat. CBC: WBC 30,000/mm³ with 80% blasts.
Which stain differentiates lymphoblasts from myeloblasts?
A. Myeloperoxidase (MPO)
B. Sudan black B
C. Periodic acid-Schiff (PAS)
D. Naphthol AS-D chloroacetate esterase
Answer: C. PAS
Explanation: Lymphoblasts typically show block positivity on PAS stain, helping to
differentiate from myeloblasts.
8.
A patient has pancytopenia and a hypocellular marrow. Which test confirms a
diagnosis of aplastic anemia?
A. Bone marrow biopsy
B. Reticulocyte count
C. Coagulation profile
D. Flow cytometry for CD55 and CD59
Answer: A. Bone marrow biopsy
Explanation: Direct visualization of bone marrow cellularity establishes diagnosis.
9.
Which test is most useful in distinguishing Polycythemia vera from secondary
polycythemia?
A. JAK2 mutation analysis
B. Hematocrit
C. Erythropoietin level
D. Bone marrow aspirate
Answer: A. JAK2 mutation analysis
Explanation: Polycythemia vera is associated with JAK2 mutations, which are not seen
in secondary causes.
10.
To distinguish von Willebrand disease (vWD) from mild hemophilia A (factor VIII
deficiency), which test is most informative?
A. Factor VIII assay
B. von Willebrand factor antigen and activity
C. PT
D. Platelet count
Answer: B. vWF antigen and activity
Explanation: Both conditions may have reduced factor VIII, but vWF testing is
diagnostic in vWD.
11.
A 72-year-old with multiple myeloma undergoes serum protein electrophoresis.
Which pattern is classic?
A. Monoclonal spike in gamma region
B. Broad beta zone elevation
C. Hypogammaglobulinemia
D. Polyclonal increase
Answer: A. Monoclonal spike in gamma region
Explanation: A sharp M-protein spike is diagnostic for myeloma.
12.
A child presents with purpura and no hepatosplenomegaly. Platelet count is low.
Which is confirmatory for ITP?
A. Bone marrow aspirate
B. Platelet antibody assay
C. Bleeding time
D. Coombs test
Answer: B. Platelet antibody assay
Explanation: Detection of anti-platelet antibodies confirms immune thrombocytopenia.
13.
Best initial screening test for hereditary hemolytic anemias?
A. Direct antiglobulin (Coombs) test
B. Haptoglobin assay
C. Peripheral blood smear
D. Reticulocyte count
Answer: C. Peripheral blood smear
Explanation: Smear shows spherocytes, sickle cells, or schistocytes, guiding further
testing.
14.
A young male has repeated DVTs. Which test is diagnostic for antithrombin III
deficiency?
A. Activated partial thromboplastin time (aPTT)
B. Functional antithrombin III assay
C. Clot solubility test
D. D-dimer
Answer: B. Functional antithrombin III assay
Explanation: Measures antithrombin activity, confirming deficiency.
15.
In sickle cell anemia, which test is used to confirm the diagnosis?
A. Sickling test
B. Hemoglobin electrophoresis
C. Coomb's test
D. Supravital stain for Heinz bodies
Answer: B. Hemoglobin electrophoresis
Explanation: Detects abnormal HbS band.
16.
Which laboratory finding strongly supports the diagnosis of disseminated
intravascular coagulation (DIC)?
A. Isolated thrombocytopenia
B. Elevated fibrin degradation products
C. Isolated prolonged aPTT
D. Increased factor VIII activity
Answer: B. Elevated fibrin degradation products
Explanation: FDPs are increased due to pathologic fibrin breakdown in DIC.
17.
A 59-year-old man with macrocytic anemia and hypersegmented neutrophils. The
most specific direct laboratory diagnostic test?
A. Serum vitamin B12 assay
B. Schilling test
C. Serum methylmalonic acid
D. Bone marrow aspirate
Answer: A. Serum vitamin B12 assay
Explanation: Low B12 confirms deficiency, although MMA is more sensitive.
18.
In a heparinized sample, which clotting assay is most reliable?
A. Prothrombin time (PT)
B. aPTT
C. Thrombin time
D. Reptilase time
Answer: D. Reptilase time
Explanation: Reptilase time is unaffected by heparin, unlike thrombin time.
19.
A leukemia patient’s blood sample shows high white count with numerous
immature cells. Which cytochemical stain helps confirm diagnosis of acute
myeloid leukemia?
A. Myeloperoxidase (MPO)
B. Non-specific esterase
C. PAS
D. Chloroacetate esterase
Answer: A. MPO
Explanation: MPO is positive in myeloid blasts.
20.
Which automated cell counter parameter is key in identifying anemia types?
A. Mean corpuscular volume (MCV)
B. White cell count (WBC)
C. Platelet count
D. Mean cell hemoglobin concentration (MCHC)
Answer: A. MCV
Explanation: MCV helps classify anemia as microcytic, normocytic, or macrocytic.
21.
For diagnosis of paroxysmal nocturnal hemoglobinuria (PNH), which test is gold
standard?
A. Ham’s test
B. Flow cytometry for CD55/CD59
C. Sucrose lysis test
D. Direct antiglobulin test
Answer: B. Flow cytometry for CD55/CD59
Explanation: Modern diagnosis relies on absence of CD55/CD59 on RBCs by flow
cytometry.
22.
A 7-year-old with frequent gum bleeds and family history. Initial screen is normal
aPTT and PT. What is next?
A. Platelet function assay
B. Mixing study
C. Factor VIII assay
D. Thrombin time
Answer: A. Platelet function assay
Explanation: Platelet function defects are missed by PT/aPTT, so PFA is crucial.
23.
Hemoglobin H inclusions are best visualized using:
A. Wright’s stain
B. Supravital stain
C. Giemsa stain
D. PAS stain
Answer: B. Supravital stain
Explanation: Supravital stains highlight Heinz bodies (including Hb H inclusions) in
RBCs.
24.
Which test detects fetal-maternal hemorrhage in Rh-negative mothers?
A. Kleihauer-Betke test
B. Indirect Coombs test
C. Apt test
D. Acid elution test
Answer: A. Kleihauer-Betke test
Explanation: Acid elution of fetal hemoglobin stains fetal cells pink; quantifies feto-
maternal hemorrhage.
25.
A high reticulocyte count with hemolysis is seen. Which test distinguishes immune
versus non-immune hemolysis?
A. DAT (Coombs)
B. Haptoglobin
C. LDH
D. Serum bilirubin
Answer: A. Direct antiglobulin test (DAT)
Explanation: DAT detects antibodies/complement on RBCs, confirming immune
etiology.
26.
The primary test for diagnosing hereditary spherocytosis today is:
A. Eosin-5-maleimide (EMA) binding test
B. Osmotic fragility
C. Acidified glycerol lysis test
D. Autohemolysis test
Answer: A. EMA binding test
Explanation: EMA flow cytometry is now preferred due to higher sensitivity/specificity.
27.
In a suspected case of G6PD deficiency, which investigation confirms enzyme
deficiency?
A. Fluorescent spot test
B. Heinz body preparation
C. Coomb’s test
D. Methemoglobin reduction test
Answer: A. Fluorescent spot test
Explanation: Fluorescent spot test is reliable and rapid for G6PD activity.
28.
A patient receiving heparin develops thrombocytopenia. Which test confirms
heparin-induced thrombocytopenia?
A. Platelet factor 4 antibody ELISA
B. Platelet aggregation studies
C. Platelet function assay
D. Ham’s test
Answer: A. PF4 antibody ELISA
Explanation: Antibodies against PF4-heparin complexes confirm HIT.
29.
Which laboratory parameter is most useful for monitoring warfarin therapy?
A. PT/INR
B. aPTT
C. D-dimer
D. Thrombin time
Answer: A. PT/INR
Explanation: Warfarin affects vitamin K dependent factors, prolonging PT, measured as
INR.
30.
A 22-year-old female presents with bleeding episodes. Which assay distinguishes
between factor VIII and factor IX deficiency?
A. aPTT
B. Factor assay
C. PT
D. Bleeding time
Answer: B. Factor assay
Explanation: Direct measurement of factor levels is confirmatory.
31.
Which laboratory method most accurately quantifies fetal hemoglobin (HbF) in
adults?
A. Cellulose acetate electrophoresis
B. Alkali denaturation test
C. High-performance liquid chromatography (HPLC)
D. Hemoglobin solubility test
Answer: C. HPLC
Explanation: HPLC gives precise quantification of hemoglobin fractions.
32.
A child is suspected to have Fanconi anemia. Which cytogenetic assay is used for
confirmation?
A. Chromosome breakage test
B. FISH
C. Flow cytometry for CD55
D. Spectral karyotyping
Answer: A. Chromosome breakage test
Explanation: Fanconi anemia cells are hypersensitive to DNA cross-linking agents,
resulting in chromosome breaks.
33.
The best screening test to assess intrinsic pathway disorders is:
A. aPTT
B. PT
C. Platelet count
D. Bleeding time
Answer: A. aPTT
Explanation: aPTT assesses factors VIII, IX, XI, XII (intrinsic pathway).
34.
What is the gold-standard assay for paroxysmal cold hemoglobinuria?
A. Donath-Landsteiner test
B. Cold agglutinin titer
C. Direct Coomb’s test
D. Ham’s test
Answer: A. Donath-Landsteiner test
Explanation: This test detects biphasic hemolysins characteristic of PCH.
35.
Which test is most specific for diagnosing chronic myeloid leukemia (CML)?
A. Philadelphia chromosome by FISH
B. Leukocyte alkaline phosphatase score
C. Bone marrow cytology
D. Peripheral blood basophilia
Answer: A. Philadelphia chromosome by FISH
Explanation: FISH detects BCR-ABL rearrangement, pathognomonic for CML.
36.
A neonate is jaundiced with hemolysis. Which test best demonstrates Rh hemolytic
disease of the newborn?
A. Direct antiglobulin (Coombs) test
B. Hemoglobin electrophoresis
C. Reticulocyte count
D. Schilling test
Answer: A. Direct antiglobulin test
Explanation: DAT detects maternal antibodies coating baby’s RBCs.
37.
Which of the following is most appropriate for quantifying iron stores in bone
marrow?
A. Perls’ Prussian blue stain
B. Wright’s stain
C. Periodic acid-Schiff stain
D. Giemsa stain
Answer: A. Perls’ Prussian blue stain
Explanation: Iron stains blue; used to assess iron in marrow.
38.
A patient with unexplained thrombosis is tested for antiphospholipid antibody
syndrome. Which is the most specific test?
A. Lupus anticoagulant
B. Anticardiolipin antibody
C. Beta-2 glycoprotein I antibody assay
D. aPTT
Answer: C. Beta-2 glycoprotein I antibody assay
Explanation: This is the most specific laboratory marker for APS.
39.
Which test is most essential for diagnosing acute intermittent porphyria?
A. Urinary porphobilinogen
B. Serum ferritin
C. Genetic testing
D. Stool porphyrins
Answer: A. Urinary porphobilinogen
Explanation: AIP is diagnosed by elevated porphobilinogen in urine during an attack.
40.
A patient with multiple myeloma has persistent hypercalcemia and renal
dysfunction. Which laboratory finding is diagnostic?
A. Bence Jones protein in urine
B. Increased IgA
C. Increased s-β2 microglobulin
D. Elevated uric acid
Answer: A. Bence Jones protein in urine
Explanation: Free light chains (Bence Jones proteins) are key diagnostic hallmark in
myeloma.
41.
Which laboratory method is highly sensitive and specific for detecting JAK2 V617F
mutation?
A. Allele-specific PCR
B. Karyotyping
C. FISH
D. Southern blot
Answer: A. Allele-specific PCR
Explanation: This method is rapid and sensitive for point mutations.
42.
Best confirmatory test for hereditary elliptocytosis:
A. Osmotic fragility
B. EMA binding assay
C. Genetic testing
D. Autohemolysis test
Answer: C. Genetic testing
Explanation: Molecular studies confirm gene mutations in spectrin/ankyrin genes.
43.
Which investigation confirms megaloblastic anemia due to folate deficiency?
A. Serum folate assay
B. Homocysteine
C. Methylmalonic acid
D. Bone marrow aspirate
Answer: A. Serum folate assay
Explanation: Low serum folate is diagnostic; homocysteine may be elevated but is less
specific.
44.
A screening test detects increased osmotic fragility. Which condition is this most
likely seen in?
A. Hereditary spherocytosis
B. Thalassemia
C. Sickle cell disease
D. Paroxysmal nocturnal hemoglobinuria
Answer: A. Hereditary spherocytosis
Explanation: Spherocytes have increased fragility in hypotonic saline.
45.
Which is the most reliable method for detecting Philadelphia chromosome in bone
marrow?
A. RT-PCR for BCR-ABL
B. Karyotyping
C. FISH
D. Southern blot
Answer: C. FISH
Explanation: FISH is highly sensitive/specific for chromosomal translocations.
46.
Which test is used to assess plasminogen activator inhibitor-1 (PAI-1) activity in
suspected thrombotic disorders?
A. Clot lysis assay
B. ELISA for PAI-1
C. Euglobulin lysis time
D. Platelet aggregation
Answer: B. ELISA for PAI-1
Explanation: ELISA quantifies PAI-1 antigen or activity levels.
47.
A female presents with easy bruising only during pregnancy. Which test detects
acquired von Willebrand syndrome (AVWS)?
A. Ristocetin cofactor assay
B. Factor VIII assay
C. Platelet function analyzer
D. PT
Answer: A. Ristocetin cofactor assay
Explanation: Confirms loss of vWF function, as occurs in AVWS.
48.
Which hematological test is most useful in monitoring hydroxyurea therapy in
sickle cell anemia?
A. F-cell quantification
B. HbA2 measurement
C. Total leukocyte count
D. Reticulocyte count
Answer: A. F-cell quantification
Explanation: Hydroxyurea raises fetal hemoglobin in RBCs, monitored as F-cells.
49.
A neonate with delayed separation of umbilical cord and recurrent infections
should have which laboratory assay?
A. Flow cytometry for CD18
B. Nitrosamine blue test
C. Myeloperoxidase stain
D. Immunoglobulin quantification
Answer: A. Flow cytometry for CD18
Explanation: Diagnoses Leukocyte Adhesion Deficiency, due to CD18 deficiency.
50.
For monitoring the effectiveness of desmopressin in von Willebrand disease,
which parameters are essential?
A. vWF antigen and ristocetin cofactor activity
B. PT and aPTT
C. Platelet count
D. D-dimer
Answer: A. vWF antigen and ristocetin cofactor
Explanation: Both increase after desmopressin in responsive VWD patients; these are
monitored.
