ASCP Hematology Actual Review:
Complete Practice Questions with 100%
Correct Verified Answers
DOMAIN 1: HEMATOPOIESIS & CELL MORPHOLOGY (20 Questions)
Q1. A peripheral blood smear from a 3-day-old neonate shows 20% nucleated RBCs,
moderate polychromasia, and occasional myeloid precursors. The most appropriate
interpretation is:
A. Normal for age
B. Hemolytic disease of the newborn
C. Congenital leukemia
D. Bone marrow infiltration
Correct Answer: A
Rationale: Neonates normally have nucleated RBCs (up to 10/100 WBCs in first week).
Myeloid precursors may be present in peripheral blood during first week. Polychromasia
indicates reticulocytes, appropriate in newborns. HDN would show higher nRBC count,
spherocytes, positive DAT. Leukemia would show blasts, not normal precursors. Marrow
infiltration shows tear drops, immature cells, leukoerythroblastic picture.
,Q2. A bone marrow aspirate shows 60% cellularity with erythroid hyperplasia and
numerous ringed sideroblasts on iron stain. Prussian blue stain shows iron-laden
mitochondria surrounding nuclei. This is characteristic of:
A. Iron deficiency anemia
B. Sideroblastic anemia
C. Anemia of chronic disease
D. Thalassemia
Correct Answer: B
Rationale: Ringed sideroblasts = iron-laden mitochondria encircling ≥1/3 of nucleus.
Prussian blue (Perls) stain demonstrates iron in mitochondria. Erythroid hyperplasia
with ineffective erythropoiesis. Serum iron normal or increased (vs decreased in iron
deficiency). Iron deficiency shows absent marrow iron, no ringed sideroblasts. ACD
shows decreased iron stores, no ringed sideroblasts. Thalassemia shows target cells,
basophilic stippling, no ringed sideroblasts.
Q3. The normal myeloid-to-erythroid (M:E) ratio in adult bone marrow is approximately:
A. 1:1
B. 2:1 to 4:1
C. 6:1 to 10:1
D. 15:1 to 20:1
Correct Answer: B
,Rationale: Normal adult M:E ratio is 2:1 to 4:1. Ratio <2:1 indicates erythroid hyperplasia
(hemolytic anemia, blood loss, ineffective erythropoiesis). Ratio >4:1 indicates myeloid
hyperplasia (infection, leukemia, myeloproliferative neoplasm). Ratio varies with age;
infants have lower M:E ratio due to higher erythropoietic activity.
Q4. A peripheral smear shows target cells, basophilic stippling, and microcytic
hypochromic RBCs. The patient has elevated RBC count relative to hemoglobin. The
most likely diagnosis is:
A. Iron deficiency anemia
B. Beta-thalassemia trait
C. Sideroblastic anemia
D. Anemia of chronic disease
Correct Answer: B
Rationale: Beta-thalassemia trait shows microcytosis with normal or elevated RBC
count (ineffective erythropoiesis with increased RBC production). Target cells and
basophilic stippling characteristic. Iron deficiency shows low RBC count. Sideroblastic
anemia shows dimorphic population, ringed sideroblasts. ACD typically normocytic, no
target cells or basophilic stippling.
Q5. The characteristic chromatin pattern of a normal mature lymphocyte is described
as:
A. Fine and lacy
B. Clumped or smudgy (soccer ball appearance)
, C. Homogeneous and dense
D. Fine reticular with nucleoli
Correct Answer: B
Rationale: Normal mature lymphocyte has clumped, smudgy chromatin resembling
soccer ball pattern. Fine and lacy chromatin seen in blasts and immature cells.
Homogeneous and dense describes neutrophil chromatin. Fine reticular with nucleoli
describes blast cells or reactive lymphocytes.
Q6. A bone marrow aspirate stain shows black granular deposits in myeloid precursors.
This is characteristic of:
A. Myeloperoxidase (MPO) stain
B. Sudan Black B (SBB) stain
C. Periodic acid-Schiff (PAS) stain
D. Non-specific esterase (NSE) stain
Correct Answer: B
Rationale: Sudan Black B stains lipids black in myeloid granules. MPO stains
brown/black but specifically for peroxidase enzyme. PAS stains glycogen magenta. NSE
stains monocytic cells brown/black. Both MPO and SBB positive in myeloid lineage, but
SBB stains more granule types (primary and secondary) giving more intense black color.
Q7. The normal peripheral blood monocyte percentage in adults is:
A. 0-1%
Complete Practice Questions with 100%
Correct Verified Answers
DOMAIN 1: HEMATOPOIESIS & CELL MORPHOLOGY (20 Questions)
Q1. A peripheral blood smear from a 3-day-old neonate shows 20% nucleated RBCs,
moderate polychromasia, and occasional myeloid precursors. The most appropriate
interpretation is:
A. Normal for age
B. Hemolytic disease of the newborn
C. Congenital leukemia
D. Bone marrow infiltration
Correct Answer: A
Rationale: Neonates normally have nucleated RBCs (up to 10/100 WBCs in first week).
Myeloid precursors may be present in peripheral blood during first week. Polychromasia
indicates reticulocytes, appropriate in newborns. HDN would show higher nRBC count,
spherocytes, positive DAT. Leukemia would show blasts, not normal precursors. Marrow
infiltration shows tear drops, immature cells, leukoerythroblastic picture.
,Q2. A bone marrow aspirate shows 60% cellularity with erythroid hyperplasia and
numerous ringed sideroblasts on iron stain. Prussian blue stain shows iron-laden
mitochondria surrounding nuclei. This is characteristic of:
A. Iron deficiency anemia
B. Sideroblastic anemia
C. Anemia of chronic disease
D. Thalassemia
Correct Answer: B
Rationale: Ringed sideroblasts = iron-laden mitochondria encircling ≥1/3 of nucleus.
Prussian blue (Perls) stain demonstrates iron in mitochondria. Erythroid hyperplasia
with ineffective erythropoiesis. Serum iron normal or increased (vs decreased in iron
deficiency). Iron deficiency shows absent marrow iron, no ringed sideroblasts. ACD
shows decreased iron stores, no ringed sideroblasts. Thalassemia shows target cells,
basophilic stippling, no ringed sideroblasts.
Q3. The normal myeloid-to-erythroid (M:E) ratio in adult bone marrow is approximately:
A. 1:1
B. 2:1 to 4:1
C. 6:1 to 10:1
D. 15:1 to 20:1
Correct Answer: B
,Rationale: Normal adult M:E ratio is 2:1 to 4:1. Ratio <2:1 indicates erythroid hyperplasia
(hemolytic anemia, blood loss, ineffective erythropoiesis). Ratio >4:1 indicates myeloid
hyperplasia (infection, leukemia, myeloproliferative neoplasm). Ratio varies with age;
infants have lower M:E ratio due to higher erythropoietic activity.
Q4. A peripheral smear shows target cells, basophilic stippling, and microcytic
hypochromic RBCs. The patient has elevated RBC count relative to hemoglobin. The
most likely diagnosis is:
A. Iron deficiency anemia
B. Beta-thalassemia trait
C. Sideroblastic anemia
D. Anemia of chronic disease
Correct Answer: B
Rationale: Beta-thalassemia trait shows microcytosis with normal or elevated RBC
count (ineffective erythropoiesis with increased RBC production). Target cells and
basophilic stippling characteristic. Iron deficiency shows low RBC count. Sideroblastic
anemia shows dimorphic population, ringed sideroblasts. ACD typically normocytic, no
target cells or basophilic stippling.
Q5. The characteristic chromatin pattern of a normal mature lymphocyte is described
as:
A. Fine and lacy
B. Clumped or smudgy (soccer ball appearance)
, C. Homogeneous and dense
D. Fine reticular with nucleoli
Correct Answer: B
Rationale: Normal mature lymphocyte has clumped, smudgy chromatin resembling
soccer ball pattern. Fine and lacy chromatin seen in blasts and immature cells.
Homogeneous and dense describes neutrophil chromatin. Fine reticular with nucleoli
describes blast cells or reactive lymphocytes.
Q6. A bone marrow aspirate stain shows black granular deposits in myeloid precursors.
This is characteristic of:
A. Myeloperoxidase (MPO) stain
B. Sudan Black B (SBB) stain
C. Periodic acid-Schiff (PAS) stain
D. Non-specific esterase (NSE) stain
Correct Answer: B
Rationale: Sudan Black B stains lipids black in myeloid granules. MPO stains
brown/black but specifically for peroxidase enzyme. PAS stains glycogen magenta. NSE
stains monocytic cells brown/black. Both MPO and SBB positive in myeloid lineage, but
SBB stains more granule types (primary and secondary) giving more intense black color.
Q7. The normal peripheral blood monocyte percentage in adults is:
A. 0-1%
