ASCP Recalls Clinical Laboratory Certification Exam
Medical Technology Review - Detailed Rationales
150 Questions - Random Distribution - Bold Format
Q1: Which of the following conditions would most likely result in an elevated D-dimer level?
A. Hemophilia A
B. Factor XII deficiency
C. Disseminated intravascular coagulation (DIC) [CORRECT]
D. Liver disease with factor VII deficiency
Correct Answer: C
Correct because DIC involves widespread activation of coagulation and fibrinolysis, generating cross-linked fibrin
degradation products including D-dimer, which is markedly elevated. This matches the pathophysiology of
concurrent coagulation and fibrinolytic activation in DIC.
Q2: Which of the following is the characteristic morphologic finding in glucose-6-phosphate
dehydrogenase (G6PD) deficiency during a hemolytic crisis?
A. Sickle cells
B. Bite cells and Heinz bodies (visualized with supravital staining) [CORRECT]
C. Spherocytes
D. Schistocytes
Correct Answer: B
Correct because G6PD deficiency causes oxidative denaturation of hemoglobin during stress, producing Heinz
bodies (denatured hemoglobin) that are removed by splenic macrophages, leaving characteristic bite cells. This
matches the morphological hallmark of G6PD deficiency hemolysis.
Q3: Which of the following is the minimum personal protective equipment (PPE) required when
processing routine clinical laboratory specimens?
A. Gloves, laboratory coat, and eye protection when there is potential for splashing [CORRECT]
B. Full-face shield, double gloves, and shoe covers at all times
C. N95 respirator and disposable gown for all specimens
D. Gloves only are sufficient for all laboratory work
Correct Answer: A
Correct because Standard Precautions require gloves for all specimen handling, a laboratory coat for skin protection,
and eye/face protection when there is a risk of splashing or aerosol generation. This matches the CDC and OSHA
recommendations for laboratory PPE.
Q4: Which of the following transfusion reactions is most commonly associated with febrile non-hemolytic
reactions?
A. ABO incompatibility
B. Cytokine accumulation in stored blood products [CORRECT]
C. IgA deficiency in the recipient
1
, D. Bacterial contamination of the blood product
Correct Answer: B
Correct because febrile non-hemolytic transfusion reactions (FNHTR) are caused by cytokines (IL-1, IL-6,
TNF-alpha) that accumulate in stored platelet and red cell products, activating the recipient's immune response. This
matches the pathophysiology of the most common transfusion reaction.
Q5: According to OSHA's Bloodborne Pathogens Standard, which of the following is required when
handling blood and other potentially infectious materials?
A. Double gloving for all procedures
B. Use of Standard Precautions (universal precautions) [CORRECT]
C. N95 respirator for all laboratory work
D. Full-body positive-pressure suits
Correct Answer: B
Correct because OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires the use of Standard
Precautions, treating all blood and body fluids as potentially infectious. This matches the foundational occupational
safety requirement for healthcare workers.
Q6: A patient's serum glucose is measured at 320 mg/dL. The laboratory's reportable range for glucose is
20-400 mg/dL. A dilution is made by adding 0.1 mL of serum to 0.4 mL of diluent. What is the dilution
factor, and what is the reported glucose value if the diluted result is 68 mg/dL?
A. 1:5 dilution; reported value of 340 mg/dL [CORRECT]
B. 1:5 dilution; reported value of 68 mg/dL
C. 1:4 dilution; reported value of 272 mg/dL
D. 1:6 dilution; reported value of 408 mg/dL
Correct Answer: A
Correct because the dilution factor is total volume (0.5 mL) divided by serum volume (0.1 mL) = 1:5, and the
reported value is the diluted result multiplied by the dilution factor: 68 x 5 = 340 mg/dL. This matches the standard
dilution calculation protocol.
Q7: A 30-year-old male has a history of recurrent deep vein thrombosis. Laboratory testing reveals a
normal PT, prolonged aPTT that corrects with a mixing study, and decreased factor VIII activity. Which
of the following is the most likely diagnosis?
A. Hemophilia A [CORRECT]
B. Von Willebrand disease
C. Antiphospholipid antibody syndrome
D. Factor XII deficiency
Correct Answer: A
Correct because hemophilia A is caused by factor VIII deficiency, which prolongs aPTT, corrects with a mixing study
(factor replacement), and causes recurrent thrombotic bleeding. This matches the X-linked inheritance pattern and
laboratory profile of classic hemophilia.
Q8: Which of the following is the most common cause of ABO discrepancy between forward and reverse
grouping?
A. Rouleaux formation
B. Weak subgroups of A or B antigen [CORRECT]
C. Cold agglutinin disease
2
, D. Hemolysis of the specimen
Correct Answer: B
Correct because weak subgroups (such as A2 or A3) express reduced antigen density on the red cell surface, causing
weak or absent forward typing while reverse grouping shows expected results. This matches the most frequent
explanation for ABO discrepancies encountered in the blood bank.
Q9: Which of the following organisms requires a buffered charcoal yeast extract (BCYE) agar for
primary isolation?
A. Haemophilus influenzae
B. Legionella pneumophila [CORRECT]
C. Neisseria gonorrhoeae
D. Streptococcus pneumoniae
Correct Answer: B
Correct because L. pneumophila requires BCYE agar supplemented with L-cysteine and iron for primary isolation,
as it cannot grow on standard media. This matches the specific nutritional requirements of Legionella.
Q10: A troponin I result of 0.8 ng/mL is reported. The laboratory's critical value for troponin I is 0.4
ng/mL. Which of the following is the most appropriate action?
A. Record the result and file it in the patient chart
B. Immediately notify the ordering physician or responsible healthcare provider [CORRECT]
C. Repeat the test to confirm before reporting
D. Report the result at the end of the day with other results
Correct Answer: B
Correct because a critical value exceeds the established threshold for life-threatening conditions and requires
immediate notification of the physician or responsible healthcare provider. This matches the critical value
notification policy required by laboratory accreditation standards.
Q11: A patient's urine shows 3+ protein on dipstick but the sulfosalicylic acid (SSA) test is negative.
Which of the following is the most likely cause of this discrepancy?
A. Albuminuria
B. Bence Jones proteinuria (light chain proteinuria) [CORRECT]
C. Microalbuminuria
D. Hemoglobinuria
Correct Answer: B
Correct because the dipstick primarily detects albumin and may miss Bence Jones (light chain) proteins, while the
SSA test precipitates all proteins; a positive dipstick with negative SSA suggests a false-positive dipstick from
contamination, whereas the reverse pattern indicates non-albumin proteins. This matches the differential protein
detection properties of these two methods.
Q12: A serum protein electrophoresis shows a sharp spike in the gamma region. Serum immunofixation
reveals a monoclonal IgG kappa band. Which of the following is the most likely diagnosis?
A. Polyclonal gammopathy secondary to chronic infection
B. Monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma [CORRECT]
C. Autoimmune hepatitis
D. Acute inflammatory response
Correct Answer: B
3
, Correct because a sharp monoclonal spike on SPEP with confirmation by immunofixation as a single IgG kappa
band is characteristic of a plasma cell dyscrasia such as MGUS or multiple myeloma. This matches the classic
electrophoretic pattern of monoclonal gammopathies.
Q13: Which of the following is the primary method for preparing cryoprecipitate from fresh frozen
plasma?
A. Chemical extraction using ethanol precipitation
B. Thawing FFP at 1-6 degrees Celsius and centrifuging to collect the precipitate [CORRECT]
C. Chromatographic separation of plasma proteins
D. Freeze-drying FFP and reconstituting in a smaller volume
Correct Answer: B
Correct because cryoprecipitate is prepared by slowly thawing FFP at 1-6 degrees Celsius, which causes
cold-insoluble proteins (fibrinogen, factor VIII, vWF, factor XIII, fibronectin) to precipitate. This matches the
standard blood bank preparation method for cryoprecipitate.
Q14: A 65-year-old patient has a serum protein electrophoresis showing a broad-based increase in the
gamma globulin region without a discrete spike. Serum immunofixation shows polyclonal IgG and IgA.
Which of the following is the most likely diagnosis?
A. Multiple myeloma
B. Polyclonal gammopathy secondary to chronic inflammation or liver disease [CORRECT]
C. Monoclonal gammopathy of undetermined significance
D. Waldenstrom macroglobulinemia
Correct Answer: B
Correct because a broad-based (polyclonal) increase in gamma globulins without a discrete spike, confirmed by
polyclonal immunofixation, indicates a reactive process such as chronic inflammation, infection, or liver disease.
This matches the distinction between polyclonal and monoclonal gammopathies.
Q15: Which of the following is the recommended anticoagulant for coagulation studies?
A. EDTA
B. Sodium citrate (3.2%) [CORRECT]
C. Lithium heparin
D. Sodium fluoride
Correct Answer: B
Correct because 3.2% sodium citrate is the standard anticoagulant for coagulation studies, chelating calcium in a
specific ratio (9:1 blood:anticoagulant) to preserve the coagulation factors. This matches the CLSI standard for
coagulation specimen collection.
Q16: A molecular test for BCR-ABL fusion transcript is performed on a patient with chronic myeloid
leukemia. Which of the following techniques is most commonly used for this analysis?
A. Conventional karyotyping
B. Reverse transcription PCR (RT-PCR) [CORRECT]
C. Southern blot analysis
D. Western blot for BCR-ABL protein
Correct Answer: B
Correct because RT-PCR is the most sensitive and widely used method for detecting and quantifying BCR-ABL
fusion transcripts from RNA, enabling both diagnosis and monitoring of treatment response. This matches the
International Scale for standardized BCR-ABL monitoring.
4
Medical Technology Review - Detailed Rationales
150 Questions - Random Distribution - Bold Format
Q1: Which of the following conditions would most likely result in an elevated D-dimer level?
A. Hemophilia A
B. Factor XII deficiency
C. Disseminated intravascular coagulation (DIC) [CORRECT]
D. Liver disease with factor VII deficiency
Correct Answer: C
Correct because DIC involves widespread activation of coagulation and fibrinolysis, generating cross-linked fibrin
degradation products including D-dimer, which is markedly elevated. This matches the pathophysiology of
concurrent coagulation and fibrinolytic activation in DIC.
Q2: Which of the following is the characteristic morphologic finding in glucose-6-phosphate
dehydrogenase (G6PD) deficiency during a hemolytic crisis?
A. Sickle cells
B. Bite cells and Heinz bodies (visualized with supravital staining) [CORRECT]
C. Spherocytes
D. Schistocytes
Correct Answer: B
Correct because G6PD deficiency causes oxidative denaturation of hemoglobin during stress, producing Heinz
bodies (denatured hemoglobin) that are removed by splenic macrophages, leaving characteristic bite cells. This
matches the morphological hallmark of G6PD deficiency hemolysis.
Q3: Which of the following is the minimum personal protective equipment (PPE) required when
processing routine clinical laboratory specimens?
A. Gloves, laboratory coat, and eye protection when there is potential for splashing [CORRECT]
B. Full-face shield, double gloves, and shoe covers at all times
C. N95 respirator and disposable gown for all specimens
D. Gloves only are sufficient for all laboratory work
Correct Answer: A
Correct because Standard Precautions require gloves for all specimen handling, a laboratory coat for skin protection,
and eye/face protection when there is a risk of splashing or aerosol generation. This matches the CDC and OSHA
recommendations for laboratory PPE.
Q4: Which of the following transfusion reactions is most commonly associated with febrile non-hemolytic
reactions?
A. ABO incompatibility
B. Cytokine accumulation in stored blood products [CORRECT]
C. IgA deficiency in the recipient
1
, D. Bacterial contamination of the blood product
Correct Answer: B
Correct because febrile non-hemolytic transfusion reactions (FNHTR) are caused by cytokines (IL-1, IL-6,
TNF-alpha) that accumulate in stored platelet and red cell products, activating the recipient's immune response. This
matches the pathophysiology of the most common transfusion reaction.
Q5: According to OSHA's Bloodborne Pathogens Standard, which of the following is required when
handling blood and other potentially infectious materials?
A. Double gloving for all procedures
B. Use of Standard Precautions (universal precautions) [CORRECT]
C. N95 respirator for all laboratory work
D. Full-body positive-pressure suits
Correct Answer: B
Correct because OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030) requires the use of Standard
Precautions, treating all blood and body fluids as potentially infectious. This matches the foundational occupational
safety requirement for healthcare workers.
Q6: A patient's serum glucose is measured at 320 mg/dL. The laboratory's reportable range for glucose is
20-400 mg/dL. A dilution is made by adding 0.1 mL of serum to 0.4 mL of diluent. What is the dilution
factor, and what is the reported glucose value if the diluted result is 68 mg/dL?
A. 1:5 dilution; reported value of 340 mg/dL [CORRECT]
B. 1:5 dilution; reported value of 68 mg/dL
C. 1:4 dilution; reported value of 272 mg/dL
D. 1:6 dilution; reported value of 408 mg/dL
Correct Answer: A
Correct because the dilution factor is total volume (0.5 mL) divided by serum volume (0.1 mL) = 1:5, and the
reported value is the diluted result multiplied by the dilution factor: 68 x 5 = 340 mg/dL. This matches the standard
dilution calculation protocol.
Q7: A 30-year-old male has a history of recurrent deep vein thrombosis. Laboratory testing reveals a
normal PT, prolonged aPTT that corrects with a mixing study, and decreased factor VIII activity. Which
of the following is the most likely diagnosis?
A. Hemophilia A [CORRECT]
B. Von Willebrand disease
C. Antiphospholipid antibody syndrome
D. Factor XII deficiency
Correct Answer: A
Correct because hemophilia A is caused by factor VIII deficiency, which prolongs aPTT, corrects with a mixing study
(factor replacement), and causes recurrent thrombotic bleeding. This matches the X-linked inheritance pattern and
laboratory profile of classic hemophilia.
Q8: Which of the following is the most common cause of ABO discrepancy between forward and reverse
grouping?
A. Rouleaux formation
B. Weak subgroups of A or B antigen [CORRECT]
C. Cold agglutinin disease
2
, D. Hemolysis of the specimen
Correct Answer: B
Correct because weak subgroups (such as A2 or A3) express reduced antigen density on the red cell surface, causing
weak or absent forward typing while reverse grouping shows expected results. This matches the most frequent
explanation for ABO discrepancies encountered in the blood bank.
Q9: Which of the following organisms requires a buffered charcoal yeast extract (BCYE) agar for
primary isolation?
A. Haemophilus influenzae
B. Legionella pneumophila [CORRECT]
C. Neisseria gonorrhoeae
D. Streptococcus pneumoniae
Correct Answer: B
Correct because L. pneumophila requires BCYE agar supplemented with L-cysteine and iron for primary isolation,
as it cannot grow on standard media. This matches the specific nutritional requirements of Legionella.
Q10: A troponin I result of 0.8 ng/mL is reported. The laboratory's critical value for troponin I is 0.4
ng/mL. Which of the following is the most appropriate action?
A. Record the result and file it in the patient chart
B. Immediately notify the ordering physician or responsible healthcare provider [CORRECT]
C. Repeat the test to confirm before reporting
D. Report the result at the end of the day with other results
Correct Answer: B
Correct because a critical value exceeds the established threshold for life-threatening conditions and requires
immediate notification of the physician or responsible healthcare provider. This matches the critical value
notification policy required by laboratory accreditation standards.
Q11: A patient's urine shows 3+ protein on dipstick but the sulfosalicylic acid (SSA) test is negative.
Which of the following is the most likely cause of this discrepancy?
A. Albuminuria
B. Bence Jones proteinuria (light chain proteinuria) [CORRECT]
C. Microalbuminuria
D. Hemoglobinuria
Correct Answer: B
Correct because the dipstick primarily detects albumin and may miss Bence Jones (light chain) proteins, while the
SSA test precipitates all proteins; a positive dipstick with negative SSA suggests a false-positive dipstick from
contamination, whereas the reverse pattern indicates non-albumin proteins. This matches the differential protein
detection properties of these two methods.
Q12: A serum protein electrophoresis shows a sharp spike in the gamma region. Serum immunofixation
reveals a monoclonal IgG kappa band. Which of the following is the most likely diagnosis?
A. Polyclonal gammopathy secondary to chronic infection
B. Monoclonal gammopathy of undetermined significance (MGUS) or multiple myeloma [CORRECT]
C. Autoimmune hepatitis
D. Acute inflammatory response
Correct Answer: B
3
, Correct because a sharp monoclonal spike on SPEP with confirmation by immunofixation as a single IgG kappa
band is characteristic of a plasma cell dyscrasia such as MGUS or multiple myeloma. This matches the classic
electrophoretic pattern of monoclonal gammopathies.
Q13: Which of the following is the primary method for preparing cryoprecipitate from fresh frozen
plasma?
A. Chemical extraction using ethanol precipitation
B. Thawing FFP at 1-6 degrees Celsius and centrifuging to collect the precipitate [CORRECT]
C. Chromatographic separation of plasma proteins
D. Freeze-drying FFP and reconstituting in a smaller volume
Correct Answer: B
Correct because cryoprecipitate is prepared by slowly thawing FFP at 1-6 degrees Celsius, which causes
cold-insoluble proteins (fibrinogen, factor VIII, vWF, factor XIII, fibronectin) to precipitate. This matches the
standard blood bank preparation method for cryoprecipitate.
Q14: A 65-year-old patient has a serum protein electrophoresis showing a broad-based increase in the
gamma globulin region without a discrete spike. Serum immunofixation shows polyclonal IgG and IgA.
Which of the following is the most likely diagnosis?
A. Multiple myeloma
B. Polyclonal gammopathy secondary to chronic inflammation or liver disease [CORRECT]
C. Monoclonal gammopathy of undetermined significance
D. Waldenstrom macroglobulinemia
Correct Answer: B
Correct because a broad-based (polyclonal) increase in gamma globulins without a discrete spike, confirmed by
polyclonal immunofixation, indicates a reactive process such as chronic inflammation, infection, or liver disease.
This matches the distinction between polyclonal and monoclonal gammopathies.
Q15: Which of the following is the recommended anticoagulant for coagulation studies?
A. EDTA
B. Sodium citrate (3.2%) [CORRECT]
C. Lithium heparin
D. Sodium fluoride
Correct Answer: B
Correct because 3.2% sodium citrate is the standard anticoagulant for coagulation studies, chelating calcium in a
specific ratio (9:1 blood:anticoagulant) to preserve the coagulation factors. This matches the CLSI standard for
coagulation specimen collection.
Q16: A molecular test for BCR-ABL fusion transcript is performed on a patient with chronic myeloid
leukemia. Which of the following techniques is most commonly used for this analysis?
A. Conventional karyotyping
B. Reverse transcription PCR (RT-PCR) [CORRECT]
C. Southern blot analysis
D. Western blot for BCR-ABL protein
Correct Answer: B
Correct because RT-PCR is the most sensitive and widely used method for detecting and quantifying BCR-ABL
fusion transcripts from RNA, enabling both diagnosis and monitoring of treatment response. This matches the
International Scale for standardized BCR-ABL monitoring.
4
