1. Heparin is a natural anticoagulant that is originally isolated from?

a. liver b. heart
c. kidney d. bone marrow
* Heparin, a mucoitin polysulfuric acid, is an effective anticoagulant in small quantities without significant effect on many determinations.

2. Which among the following is the correct sequence for venipuncture procedure?
a. Patient interaction- Specimen Preparation-Assembly of
supplies- Venipuncture
b. Assembly of supplies-Patient interaction-Venipuncture-
Specimen Preparation
c. Patient Interaction-Assembly of supplies-Venipuncture-
Specimen Preparation
d. Assembly of supplies-Patient Interaction-Specimen
Preparation-Venipuncture

3. What period of hematopoiesis is considered as the counterpart of extramedullary hematopoiesis in adults?

a. mesoblastic b. embryonic
c. hepatic d. myeloid
* Extramedullary hematopoiesis includes the production of blood cells in sites other than the bone marrow. Hepatic period of
hematopoiesis (occurs in the liver) is considered as the counterpart in fetal development

4. Which among the following is true about the periods of blood cell production?
a. Bone marrow becomes the only normal site for blood cell production after birth
b. Gower I, Gower II and Portland are fetal forms of hemoglobin
c. The spleen, lymph nodes and thymus also become active in blood cell production during hepatic period
d. none of the above
* 1-2 weeks after birth, the liver may still produce blood cells at a smaller degree. But after three weeks, bone marrow solely becomes the
only normal site for hematopoiesis.
*Gower I, II and Portland are embryonic forms of hemoglobin

5. The following are considered as hematopoietic sites in adults:

1- skull
2- pelvis
3 – shafts of long bones
4 – vertebrae
a. 1,2,3,4 b. 1,2,3
c. 1,2,4 d. 2,3,4
*Fatty reserves start to develop in the shafts of long bones

6. Primary blood cell formation occurs at which part of the bone marrow?
a. marrow sinus b. endosteum (a membrane lining the marrow cavity of the bone)
c. cords d. central vein
* Occurs at the hematopoietic cords

7. This is the term use when stem cells lose their potential to develop as any other cell lineage
a. restricted b. committed
c. pluripotent d. totipotent

8. Which of the following are considered as committed stem cells?

1- CFU-S (pluripotent stem cell)
2- CFU- GM (granulocyte-macrophage)
3 – THSC (totipotent stem cell)
4 – CFU-Eo (eosinophil)
a. 1 and 3 b. 2 and 4
c. 1,2,4 d. 1, 2,3,4

9. All but one have positive effects on CFU-S:

a. phytohemagglutinin b. concanavalin A
c. hydroxyurea d. cyclophosphamide
*Positive effects may include cell proliferation, increase in CFU-S number, increase in survival and protection form death.

10. Burst-Forming units are named as such because?

a. random colony formation was observed after the addition of small amounts of EPO
b. bursts of colonies were observed after the addition of small amount of EPO
c. clusters of colonies were observed after the addition of large amount of EPO
d. random colonies were observed after the addition of large amount of EPO
*plasma clot +bone marrow cells + small EPO = random colonies formed
*large amounts of EPO: CFU-E are formed and diminished then after 7 days cluster of colonies or burst of colonies were observed and
believed to have been caused by a CFU-E progenitor which lead to the formation of many CFU-Es
11. Erythropoiesis may be inhibited by the actions of which of the following?
a. T-lymphocytes b. growth hormone
c. Insulin d. both a and b
*In conditions where there are increased T-lymph proliferation, decreased RBCs are observed (Chronic lymphocytic leukemia and red cell
aplasia) other inhibitors include: viruses, interferons, uremic toxins and alcohol.

12. The clinical usefulness of this radioisotope is limited because it requires an instrument that is not usually present in laboratories.
a. Fe 59 (long half life, poor imaging due to high energy production)
b. Tc 99
c. Fe 52 (also, the short half life makes it not ideal for transport)
d. H3
*Cyclotron a highly sophisticated and expensive instrument is required

13. The following statements are correct regarding the nucleus of red blood cells which one is not?
a. Nucleus is the site of DNA and RNA synthesis
b. Euchromatin is the active form of chromatin
c. Heterochromatin is an inactive more condensed area of chromatin
d. both types of chromatin takes up a basophilic color when stained
*Heterochromatin is the form that takes up a basophilic color once stayed with a basic dye

14. Which of the following descriptions agrees with the guidelines set for the identification of an immature cell?
a. The size of the cell observed is approximately 7 um
b. Chromatin are coarser and denser in appearance
c. The cytoplasm of the cell is pinkish in color
d. none of the above
* decrease in size, decreased degree of cytoplasmic basophilia, from round or oval to very round nuclei, Increased degree of
coarseness and
condensation of chromatin

15. What erythroid precursor cell is often mistaken as a lymphocyte?

a. rubriblast (mistaken as myeloblast)
b. prorubricyte
c. rubricyte
d. reticulocyte
* rubricyte (sometimes metarubricyte) is mistaken as lymphocyte:
- the difference is that lymphocyte has less coarser chromatin and less abundant cytoplasm and is distinctly basophilic

16. What stage of erythrocyte maturation does cell division occurs twice?
a. rubriblast
b. prorubricyte
c. rubricyte
d. metarubricyte
* prorubricyte undergoes cell division twice and each will give rise to 4 rubricytes

17. Basophilic normoblast is the 2nd stage in RBC maturation and is primarily differentiated from rubriblast by:
a. the presence of nucleoli in the 2nd stage
b. coarser chromatin found in rubriblasts
c. either of the two
d. neither of the two

18. In what stage of erythrocyte maturation does hemoglobin becomes the main constituent of the cytoplasm
a. rubriblast
b. metarubricyte (ortho chromatohilic: pinkish color quite similar to erythrocytes)
c. rubricyte (1st stage of hemoglobin synthesis)
d. prorubricyte

19. The biconcave shape of red blood cells facilitates:

a. transport of oxygen and carbon dioxide
b. deformability and flexibility of the cell
c. selective permeability of the cell (primarily attributed to the membrane composition of the cell)
d. both a and b

20. What component of the RBC membrane is associated to the regulation of its fluidity?
a. phospholipids (arranged in bilayer, separates intra from extra cellular environment and passage of nutrients/electrolytes)
b. unesterified cholesterol (98% of the membrane cholesterol component)
c. esterified cholesterol (70% of the plasma cholesterol)
d. proteins

21. This component of the peripheral proteins gives red blood cells a negative charge which allows them to repel against one another as
they move through the circulation:
a. sialic acid (found as part of the integral proteins )
b. spectrin (band 1 and 2 )
c. actin (band 5)
d. none of the above
* spectrin and actin are peripheral proteins which functions to regulate membrane shape and viscoelastic properties: deficiency of which
may lead to poikilocytosis such as spherocytosis and elliptocytosis)

22. In the Embden-Meyerhoff Pathway, a high demand for energy will most likely lead to?
a. 1,3-DPG will enter the Rappoport Luebering pathway
b. Direct metabolism of 1,3-DPG to 3-PG
c. 1,3-DPG will be catabolized to 3-PG via a bypass pathway
d. Increased the production of 2,3-DPG
*Depending on the demands of the body; 1-3-DPG will be catabolized to 3-PG via:
a. direct catabolism – to increase ATP production
b. bypass pathway – to increase 2,3-DPG production

23. What is the net yield of ATP molecules for each glucose molecules that enters the Embden-Meyerhoff pathway?
a. 2 ATP molecules
b. 3 ATP molecules
c. 4 ATP molecules
d. 6 ATP molecules
* Glucose catabolized during the first few steps in EMP requires two ATP molecules
* Further in the process, 2 ATP molecules will be formed (1,3-DPG to 3-PG direct catabolism) and another 2 ATP (pyruvate to
lactate step)

24. What is the end-product of the Embden-Meyerhoff pathway if NADH enters the methemoglobin reduction pathway?
a. lactate
b. pyruvate
c. methemoglobin
d. 2,3-DPG
*NADH and NAD are used in the pathway in two steps:
a. NAD+ is a coenzyme for glyceraldehyde-3-phosphatase dehydrogenase to 1,2-DPG
b. NADH is a coenzyme for lactate dehydrogenase to convert pyruvate to lactate
* NOTE when it is necessary, NADH enters another pathway to reduced methemoglobin to hemoglobin (ferric to ferrous) if this
occurs
pyruvate is no longer converted to lactate and becomes the end-product of EMP

25. Reduction of oxidized sulfhydryl groups will yield which of the following?
a. oxidized glutathione and sulfhydryl groups
b. reduced glutathione and sulfhydryl groups
c. oxidized glutathione and reduced sulfhydryl groups
d. reduced glutathione and oxidized sulfhydryl groups

26. The primary purpose of this pathway is to decrease the reducing potential of cells the generation of NADPH
a. Hexose Monophosphate shunt
b. Rappoport-Luebering pathway (production of 2,3-DPG)
c. Embden -Meyerhoff pathway ( ATP production)
d. none of the above
* should be increasing the reducing potential

27. What molecule enters the HMP to be catabolized to 6-phosphogluconate and generate NADPH
a. fructose-6-phosphate (acted by phosphofructokinase to be converted to fructose)
b. glucose-6-phospate
c. Glyceraldehyde-3-phosphate (acted by G-3-P dehydrogenase to be converted to 1,3-DPG)
d. phosphoenol pyruvate (acted by pyruvate kinase to be converted to pyruvate-also yielding ATP)
* via the action of glucose-phosphate dehydrogenase

28. Erythron is defined as the entire mass of immature and mature erythrocytes in intravascular locations
Production and maintenance of erythron requires normally functioning bone marrow, normal EPO, and adequate nutrients.
a. both statements are true
b. both statement are false
c. only the first statement is true
d. only the second statement is true
* Erythron includes all red cell both in the intra and extra vascular locations
* balance between production and destruction keeps the normal population of red blood cells

29. With greater blood flow, the liver plays a major role in:
a. removal of aged red cells (primarily by the spleen)
b. intravascular hemolysis of red blood cells
c. removal of severely damaged red blood cells
d. both b and c

30. Young women are said to be normally having lower RBC counts than men because:
a. young women have monthly periods
b. estrogen activity
c. men have larger body mass
d. young women are alcoholic
*estrogen has inhibiting activity against EPO

31. The complete adult hemoglobin is consist of the following EXCEPT:

a. globin composed of two sets of two different polypeptide chain
b. four molecules of protoporphyrin IX
c. four oxidized iron molecules (must be reduced form: ferrous attached to the protoporphyrin IX to form the heme component)
d. 2,3-DPG molecule

32. adult hemoglobin c a. zeta and gamma

33. fetal hemoglobin e b. alpha and epsilon
34. Gower I d c. alpha and beta
35. Gower II b d. zeta and epsilon
36. Portland a e. alpha and gamma

37. Gamma globin chains are different from alpha globin chains by:
a. the number of amino acids present
b. 10 amino acids present
c. 39 amino acid present
d. the stage of life where it is present

38. To ensure adequate oxygenation of tissues, levels of 2,3-DPG must:

a. be increased to facilitate hemoglobin affinity to oxygen
b. be decreased to facilitate tissue affinity to oxygen
c. be increased to facilitate tissue affinity to oxygen
d. be decreased to facilitate hemoglobin affinity to oxygen
* 2,3-DPG levels have inverse relationship with hemoglobin affinity to oxygen

39. When hemoglobin is oxygenated the following events occur except for one:
a. hemoglobin takes on its relaxed form
b. anionic salt bridges are formed (anionic salt bridges are broken facilitating the movement of beta chains closer to each other)
c. B-chains move closer towards each other
d. 2,3-DPG molecules is expelled

40. Heme production occurs in which part of the red blood cell?
a. mitchondria
b. cytoplasm
c. nucleus
d. both a and b
* heme synthesis: begins in the mitochondria and proceeds to the cytoplasm upon formation of D-ALA, it goes back to the cytoplasm after
the conversion to coproporphyrinogen

41. The attachment of iron to protoporphyrin IX in the presence of ferrochelatase takes place in the
a. cytoplasm
b. mitochondria
c. ribosomes
d. nucleus

42. Protoporphyrin remnants are found in excess in the mitochondria and are complexed with ___________.
a. calcium
b. iron
c. zinc
d. magnesium
*Free Erythrocyte Protoporphyrin (FEP) are protoporphyrin complexed with zinc. Increased in number when iron levels are decreased. This is
used to test for certain disorders.

43. This is the term used to described the stored form of iron in the absence of apoferritin:
a. ferritin
b. transferrin (transport protein for iron)
c. hemosiderin
d. none of the above
* iron + apoferritin = ferritin (normal iron stores)
* stored iron is in the ferric form

44. Which of the following is true about iron transport?

a. Transferrin can only transport one atom of iron (two atoms of iron simultaneously)
b. Nucleated RBCs with stored ferritin are referred to as siderocytes (sideroblasts)
c. Iron once delivered to the cell may be transported to the mitochondria for storage (for heme synthesis)
d. After releasing iron the transferrin-receptor complex moves back to the cell membrane
* transferrin returns to the circulation for further transport of more iron molecules
 45. Myoglobin is a heme containing pigment found in striated muscles
The oxygen dissociation curve for myoglobin is described as sigmoid
a. both statements are true
b. both statement are false
c. only the first statement is true
d. only the second statement is true
*myoglobin is quite like hemoglobin in that it also requires amino acids, iron and protoporphyrin IX
* the main difference is that 02 curve for myoglobin is hyperbolic while it is sigmoid for hemoglobin
*myoglobin does not easily release oxygen unless under very low 02 tension.

46. George upon seeing the girl of his dreams pass along the corridors started hyperventilating. Under this condition, it is expected that the
oxygen-dissociation curve shall be:
a. exhibiting a normal curve
b. shifting to the left
c. shifting to the right
d. hyperbolic
*hyperventilation – excessive loss of carbon dioxide: shift to the left: LOW CO2, 2,3-DPG, temperature and increased pH
- increased affinity of hemoglobin to oxygen

47. How does hemoglobin plays its role as a buffer to maintain normal pH?
a. During decreased levels of CO2, hemoglobin releases oxygen to bind to hydrogen ions
b. Hemoglobin exhibits decreased oxygen affinity to counter a decreased pH
c. In renal failure, hemoglobin releases oxygen to bind to hydrogen ions
d. Hemoglobin does not take part in the buffer systems of the body

48. In the lungs, where pH is at its highest, oxygen uptake by hemoglobin is highly favored
o When in the peripheral blood, acidic metabolites are present and oxygen is released towards the tissues
a. both statements are true
b. both statements are false
c. only the first statement is true
d. only the second statement is true
* Bohr effect – states that in order to bind hydrogen ions (in acidic environments) oxygen must be released by the hemoglobin molecule
(shift to the right)

49. Which among the following is true about Methemoglobin?

a. this hemoglobin derivative is caused by the oxidation of ferric to ferrous state (ferrous to ferric)
b. It is considered normal for hemoglobin to be spontaneously converted to methemoglobin daily
c. reduction of Methemoglobin requires a properly functioning HMS (Embden-Meyerhoff )
d. NAD+ is the main source of electron donation in the reduction process of methemoglobin (NADH)

50. Methylene blue therapy is not applicable for what type of methemoglobinemia?
a. acquired methemoglobinema
b. inherited diaphorase deficiency
c. inherited HbM methemoglobinemia
d. none of the above
*Methylene blue serves as an electron donor when diaphorase is insufficient or absent.

51. What reagent is added in the blood sample to determine the presence of carboxyhemoglobin?
a. NaOH
b. distilled water
c. methylene blue
d. KCN
*Blood sample is hemolyzed with the addition of distilled water, then sodium hydroxide is then added, the presence of light-cherry red color
indicates carboxyhemoglobin. Normal blood turns the mixture into brown.

52. Disorders of heme synthesis are knows as:

a. thalassemia
b. hemoglobinopathies
c. porphyrias
d. anemia

53. This is the only porphyria which does not exhibit photosensitivity:
a. acute intermittent porphyria
b. porphyria cutanea tarda
c. variegate porphyria
d. erythropoietic protoporphyria
*Porphyrias are often associated with skin lesions and photosensitivity and neurologic disturbances
 +Match the following enzymes with the corresponding porphyria which occurs during their deficiency
54.porphobilinogen deaminase c a. variegate porphyria
55.uroporphyrinogen decarboxylase e b. congenital erythropoietic porphyria
56.ferrochelatase d c. acute intermittent porphyria
57. coproporphyrinogen oxidase f (hereditary coproporphyria) d. protoporphyria
58. protoporphyrinogen oxidase a e. porphyria cutanea tarda
59. uroporphyrinogen synthase/cosynthase b f. none of the above

60. Which among the following porphyrias are considered neurologic in that symptoms include abdominal pain, psychotic behaviors and
neuromouscular difficulties
1- variegate porphyria 4 - protoporphyria
2- congenital erythropoietic porphyria 5 - porphyria cutanea tarda
3 - acute intermittent porphyria 6 – hereditary coproporphyria

a. 2,4,5
b. 1,3,5
c. 2,4, 6
d. 1, 3, 6

61. Cyanmethemoglobin method can be used for the measurement of all types of hemoglobin EXCEPT:
a. methemoglobin
b. non-oxygenated hemoglobin
c. sulfhemoglobin
d. carboxyhemoglobin
*sulfhemoglobin cannot be reversed back to normal hemoglobin type so it cannot be measured by this method.

Cyanmethemoglobin method is Most common method for hemoglobin concentration determination

Specimen used: venous or capillary blood
Reagents used: Drabkin’s Reagent which is composed of :
a. Potassium Ferricyanide
b. Potassium Cyanide
Hemoglobin ----- potassium Ferricyanide ---- Methemoglobin ----- Potassium cyanide ----
Cyanmethemoglobin

Cyanmethemoglobin formed will be read spectrophotometrically at an absorbance of 540 nm

The absorbance of the solution is directly proportional to the amount of Hemoglobin present.

62. Which among the following conditions may lead to rouleaux formation?
a. hyperalbuminemia
b. multiple myeloma (due to increased number of gamma globulins )
c. hypofibrinogenemia
d. all of the above
*albumin is the only protein that when increased does not promote rouleaux formation
*hyperfibrinogenemia in cases of infections, pregnancy and tissue necrosis

63. What is the hypochromic grading for red blood cells with central pallor that is ¾ of the cell diameter
a. normal
b. 1+
c. 2+
d. 3+
*normal: 1/3 of the cell diameter
1+: ½ of the cell diameter = slight
2+: 2/3 of the cell diameter = moderate
3+: ¾ of the cell diameter = moderate
4+: thin rim of hemoglobin = marked

64. Anisochromia is a term used to refer to:

a. variation in the size of red blood cells (anisocytosis)
b. variation in the shape of red blood cells (poikiocytosis)
c. presence of both hypo & normochromic RBCs
d. presence of microcytic hypochromic RBCs
*Anisochromia is the variation in the hemoglobin content of RBCs present in a blood smear

65. Which of the following conditions will you least likely found a microcytic red blood cell?
a. thalassemia
b. vitamin b12 deficiency
c. plumbism
d. sideroblastic anemia
*Microcytic cells : thalassemia, iron deficiency anemia, sideroblastic anemia, anemia of chronic disease, lead poisoning
*Macrocytic cells: vitamin b12 and folate deficiency, alcoholism, chemotherapy,
66. Approximately how many percent of red blood cells shall vary in size or in shape to be graded as a “slight degree” of anisocytosis or
poikilocytosis?
a. 5-10%
b. 10-25%
c. 5%
d.50-75%
*degree of anisocytosis or poikilocytosis:
Normal = 5%; Slight = 5-10%; 1+ = 10-25% 2+ = 25-50% 3+ = 50-75% 4+ = >75%

67. The following poikilocytes are brought by membrane abnormalities EXCEPT for:
a. spherocyte
b. schistocyte (secondary to trauma)
c. codocyte
d. mouth cell

+Match the following poikilocytes with their causes:

68. Bronze cell b a. membrane cholesterol and phospholipid loading

69. Mexican hot cell a b. band 1 and 2 deficiency
70. acanthocytes e c. overt hemolysis
71. crescent cell c d. Hb S polymerization
72. menisocyte d e. change in ratio of plasma lipids

73. Codocytes exhibit increased surface to volume ratio

Just like spherocytes, target cell has increased osmotic fragility
a. both statements are true
b. both statements are false
c. only the first statement is true (codocytes have increased surface:volume ration and decreased osmotic fragility; a bag too large for its
content)
d. only the second statement is true

74. Which of the following is incorrect regrading spherocytosis?

a. the cell does not have or lacks central pallor
b. decreased osmotic fragility
c. maybe acquired or hereditary
d. decreased membrane surface to volume ratio

75. A burr cell is differentiated from a crenated red cell in that:

a. it has evenly distributed spicules (echinocyte)
b. it has irregularly sized spicules
c. its spicules or bumps are uniformly sized (echinocyte)
d. it contains pointed spicules (acanthocyte)

76. What poikilocyte is often associated to in vitro factors such as smear preparations
a. elliptocyte (acquired in certain conditions: megaloblastic anemia, IDA, myelophthisic anemia, thalassemia and sideroblastic anemia;
protein ban 4.1 deficiency for hereditary elliptocytosis)
b. acanthocyte (change in the ratio of plasma lipids)
c. burr cells (renal diseases: increased BUN)
d. echinocyte (rapid drying of smears, substances from glass slides which changes the pH

77. Abetalipoproteinemia characterized by mild hemolytic anemia, retinal degeneration and steatorrhea is associated to what
poikilocyte?
a. codocyte
b. acanthocyte (characterized by irregularly spaced pointed spicules that are thorn like)
c. stomatocyte
d. shcistocyte

78. Red blood cells with slit-like central pallor are seen in the following conditions EXCEPT:
a. alcoholism
b. thalassemias (most often associate to target cells/codocytes
c. obstructive liver disease
d. Rh null disease
*cirrhosis is also associated to stomatocytes

79. This is associated to the presence of a rigid inclusion such as that of a heinz body which causes some of the portion of the cell to remain
behind while passing through small openings
a. keratocyte
 b. schistocyte (secondary to trauma)
c. dacryocyte
d. semi-lunar cells

80. Sickle cells are technically considered as hyperchromic cells (cells that lack central pallor: spherocytes, sickle and HB SS and SC)
o Depranocytes are always seen with the heterozygous Hb S
a. both statements are true
b. both statements are false
c. only the first statement is incorrect
d. only the second statement is incorrect
*sickled cells are elongated and pointed RBCs filled with Hemoglobin
*sickled cells are seen usually in homozygous Hb S, rare with hetero (only when o2 tension is very low that cells begin to sickle)

81. Hemoglobin SC crystals are described as:

a. Washington monument like shape
b. straight with parallel sides and one blunt protruding end
c. having finger like projections from a common crystalline center
d. all of the above

82. This rbc inclusion exhibits a positive Feulgen reaction:

a. cabot rings
b. Howell-jolly bodies
c. pappenheimer bodies
d. Hb H inclusion
*fuelgen reaction is positive when DNA is present and so Howell-jolly bodies which are DNA fragments caused by nuclear disintegration
have positive reaction

+Match the following red cell inclusions with the condition often associated to them:

83. Howell-jolly bodies e a. pyrimidine-5’- nucleotidase deficiency

84. basophillic stippling a b. babesia infection
85. pappenheimer bodies d c. G-6-PD deficiency
86.maltese cross formation b d. sideroblastic anemia
87. Heinz bodies c e. splenic atrophy
+normally Howell-jolly bodies are extruded from the cell when it passes through the splenic sinuses, that’s why when spleen is
absent or
defected, there is increased Howell-jolly bodies observed.
+in sideroblastic anemia; numerous siderotic granules form a ring around at least one third of the nucleus (pathologic ringed
sideroblast)
88. Basophillic stippling is often confused with this inclusion body that tends to appear in groups at the cell periphery
a. cabot rings
b. Howell-jolly bodies
c. pappenheimer bodies
d. Hb H inclusion
+basophilic stippling: homogenously distributed all over the cell and does not stain with Prussian blue

89. When the spleen normally removes inclusion bodies from red blood cells without destruction of the cell, this mechanism is referred to as:
a. culling
b. pitting
c. phagocytosis
d. all of the above

90. Polychromatophilic erythrocytes contains ribosomes, mitochondria and other organelles

o These cells, when supravitally stained with Wright stain will be referred to as reticulocytes (stained with new methylene blue or brilliant cresyl)
a. both statements are true
b. both statements are false
c. only the first statement is true
d. only the second statement is true

91. Heinz bodies will not be visible on a wright-stained smear and are best identified with which of the following stains?
a. crystal violet
b. methylene blue
c. brilliant cresyl blue
d. all of the above
+Heinz bodies are stained with supravital stains such as the ones above

92. The presence of multiple Heinz bodies in cell gives it a ______________ appearance:
a. bite cell (characteristic appearance when Heinz bodies are pitted by the spleen)
b. pitted golf ball
 c. grape-like
d. none of the above

93. Among which of the following are graded as positive only when present during blood smear examination?
a. sickle cells
b. ovalocytes
c. target cells
d. none of the above
+ graded as positive only: Sickle cells, Howell-jolly bodies, basophilic stippling and pappenheimer bodies

94. Cyanmethemoglobin measurements may be reported erroneously when the following factors are present:
1 – lipemic sample
2 – presence of carboxyhemoglobin
3 – extremely high leukocyte counts
4 – Hb S and Hb C

a. 1 and 3
b. 1, 3, 4
c. 1, 2, 3
d. 1, 2, 3, 4
+ lipemic samples = patient blank
+ high WBC count =centrifuge and use supernatant
+ Hb S and C, easily precipitated globulins, presence of carboxyhemoglobin (may take 1 hour for the conversion to cyanmethemoglobin
NOTE that the sample and reagent are allowed to mix ideally for 10 minutes only)

95. What component of the modified drabkin’s reagent prevents the precipitation of globulins to avoid interference due to turbidity?
a. potassium ferricyanide
b. potassium phosphate
c. potassium cyanide
d. potassium carbonate (0.1 g was added to drabkin’s before use to increase alkalinity of the solution and prevent precipitation of the
globulins)

96. All of the following statements regarding Hematocrit determination is true, EXCEPT:
a. Wintrobe tubes were historically used as a macrohematocrit technique
b. Red capillary tubes must be used for whole blood samples obtained from EDTA tubes
c. The length of the capillary tube for microhematocrit technique is 75mm
d. Microhematocrit techniques requires a 5-minute centrifugation at 10,000-15,000g
*Red capillary tube contains anti-coagulant. Used for capillary blood samples.
*Blue capillary tube has no anti-coagulant. Used for blood samples derived from tube to prevent over-anti-coagulation

97. Hematocrit is a reliable estimate of the degree of anemia, immediately after a blood loss
o In automated methods of hematocrit determination, the value increases by 0.2L/L
a. both statements are false
b. both statements are true
c. only the first statement is true
d. only the second statement is true
*immediately after blood loss, the body firstly compensate by increasing plasma volume which will in turn make falsely decreased values of
hematocrit.
*automated methods for hematocrit determination is not affected by trapped plasma

98. Which among the following will cause a falsely decreased hematocrit value?
1- excess anticoagulant
2- abnormal erythrocyte shapes
3 – dehydration
4 – inadequate centrifugation

a. 1 and 2
b. 3 and 4
c. 1 only
d. 4 only

99. Based on the rule of three, hematocrit value shall be:

a. three times that of the RBC count
b. three times that of the hemoglobin count (+/- 3)
c. the hemoglobin value divided by three
d. all of the above
*the rule of three can be used to confirm the accuracy of the erythrocyte count but is considered only applicable for normocytic and
normochromic red blood cells

100. Determine the type of red cell present when the RBC count is 4.0x10 12/L, hematocrit is equals to 36% and the hemoglobin is equals to
12g/dl
a. normocytic, normochromic
b. microcytic, hypochromic
c. normocytic, hypochromic
d. macrocytic, hyperchromic

101. What RBC index is not used in the classification and differentiation of anemia?
a. MCV
b. MCH
c. MCHC
d. all indices are used

102. How many erythrocytes should be counted during reticulocyte count using routine light microscope method?
a. 1000 red blood cells excluding reticulocytes
b. 500 red blood cells including reticulocytes
c. 1,000 red blood cells including reticulocytes
d. 500 red blood cells excluding reticulocytes

103. Using the calibrated disk method, the following statements are true EXCEPT:
a. smaller square B is used to count the number of erythrocytes present
b. reticulocytes in the square B are excluded in the count for erythrocytes
c. a total of 500 erythrocytes must be counted
d. theoretically, the number of reticulocytes in 4500 erythrocytes are counted.
*reticulocytes in square B are counted both as erythrocytes and reticulocytes
* square B is 1/9 the sized of square A (500 x 9 =4500)

104. This reflects the actual number of reticulocytes in one liter of whole blood
a. reticulocyte count (expressed in percentage as the number of retic per 1000 RBCs)
b. absolute reticulocyte count (retic count in percent /100 x RBC count x 1000)
c. corrected reticulocyte count (a.k.a hematocrit correction; corrects the observed retic count to a normal Hct of 0.45L/L)
d. reticulocyte index ( retic count x patient Hct/ 0.45L/L; normally CRC shall be approx.. 1%)

105. Determine if the rate of reticulocyte production serves as an adequate response to degree of anemia when the patient has a
Reticulocyte count of 5% and a hematocrit of 0.24 L/L.
a. adequate response
b. inadequate response (RPI is 1.3; that is less than 2 so considered as inadequate response)
c. cannot be determined
d. either a or b

105. Blood samples spun for hematocrit determination will have layers arranged from top to bottom as follows:
a. packed red cell, buffy coat, plasma layer, fatty layer
b. plasma layer, fatty layer, buffy coat, packed red cell
c. fatty layer, plasma layer, buffy coat, packed red cell
d. packed red cell, plasma layer, buffy coat, fatty layer

106. Erythrocyte sedimentation rate is _________________ proportional to red cell mass and _______________ proportional to plasma viscosity.
a. ESR is directly proportional to both
b. ESR is inversely proportional to both
c. directly, inversely
d. inversely, directly
*small red cell mass settles slowly and that normal red cells do not form roleuax (low cell mass = low ESR)
*mas lapuyot dugay mag settle

107. What is the ratio of blood sample to anticoagulant if 3.8% sodium citrate is used for ESR determinations:
a. 9:1
b. 4:1
c. 1:1
d. only EDTA tubes can be used in ESR determinations

108. Which among the following is not correct regarding ESR determination?
a. ESR does not measure the rate of settling of RBCs (rather it measures the distance settled after a specified time – 1 hour)
b. Westergren tube has a length of approximately 30 cm with an internal bore of 2.65mm
c. ESR determination is performed on the right side of the wintrobe tube (100-0mm gradings from top to bottom)
d. Wintrobes tubes are 115 mm long with an internal bore of 3mm
*In wintrobe left side is used for ESR determination with gradings of 0-100mm from top to bottom)
WESTERGREN WINTROBE
Tube 300 mm long 115mm long
Graduation 200mm 100mm
Lines
Bore Internal bore: 2.65 Internal bore:3mm
mm
Extrenal bore:
5.5mm
109. Established approximate values for ESR vary with age and gender, based on Westergren ESR reference values all the following are not
true except for one:
a. females have lower ESR values compared to males
b. ESR values decreases as an individual ages
c. normal ESR value for children is approximately 0-30 mm (ESR for females > 50 y.o.)
d. none of the above

110. * blood samples at room temperature for ESR determination are stable for up to 2 hours
* at 4deg Celsius specimens are reported to be stable for up to 6 or 12 hours
a. both statements are true
b. both statements are false
c. only the first statement is true
d. only the second statement is true

+Identify whether the following conditions will result to increased or normal ESR values:

111. Sickle cell anemiab a. increased

112. Multiple myeloma a b. normal
113. Hereditary spherocytosis b
114. waldenstrom’s macroglobulinemia a
115. polycythemia vera b

116. Relative anemia may be observed in which of the following conditions?

1-pregnancy (plasma volume increases more during pregnancy than that of RBC increase)
2 – hyperproteinemia (increased orthostatic pressure fluid shift toward the intravascular compartments)
3 – fluid shift from extravascular to intravascular components
a. 3 only b. 1 and 2 c. 2 and 3 only d. 1,2 and 3

117. Anemia is best defined in reference to a decreased hematocrit value

Polycythemia on the other hand is best defined in reference to increased hemoglobin values
a. both statements are true
b. both statements are false
c. only the first statement is true
d. only the second statement is
*the primary consequence in anemia is the decreased oxygen carrying capacity of blood
*polycythemia have hematocrit levels above the established reference range

118. Anemia may be categorized based on its possible causative mechanism. Which among the following is characterized by
decreased or
ineffective bone marrow function?
a. blood loss b. hemolytic anemias c. maturation disorders d. none of the above

119. When the oxygen carrying capacity of the blood is decreased, what is the body’s first mechanism for compensation?
a. increased bone marrow stimulation (slowest but more effective response)
b. increased cardiac output (3rd response)
c. selective redistribution of blood flow (2nd response)
d. increased 2,3-DPG levels (shift to the right to decrease hemoglobin affinity to oxygen and increase delivery to tissues)

120. Stress and tobacco smoking is associated which of the following?

a. absolute primary erythrocytosis
b. relative erythrocytosis
c. secondary erythrocytosis (appropriate)
d. secondary erythrocytosis (inappropriate)

+Classify the following conditions/types of anemia based on their etiology

121. hereditary spherocytosis d a. relative anemia

122. Cobalamin deficiency b b. anemia of impaired DNA synthesis
123. Iron deficiency anemiaf c. anemia of impaired bone marrow
124. Myelophthisic anemia c d. anemia of increased cell destruction and decreased cell survival
125. Microangiopathic hemolytic anemia d e. anemia of blood loss
126. pyruvate kinase deficiency d f. anemia of defective hemoglobin synthesis
127. Aplastic anemia c
128. Anemia of renal failure c
129. hemoglobinopathies d
130. hypovolemia e

131. In polycythemia vera, erythropoietin levels are observed to be

a. increased b. decreased c. normal d. cannot be determined
*EPO is decreased as a negative feedback mechanism so that no further cell proliferation takes place
132. What is the main or most serious clinical problem placed by individuals with aplastic anemia?
a. decreased oxygen delivery (hypoxia)
b. neutropenia
c. thrombocytopenia
d. both b and c
*misleading ang term na anemia

133. The following conditions occurs during aplastic anemia:

a. increased activity of splenic cells
b. no immature myeloid cells found in the peripheral blood
c. hematologic cell production is increased
d. presence of splenomegaly in some patients

134. This refers to the inherited form of aplastic anemia

a. Diamond-Blackfan syndrome
b. Fanconi syndrome
c. Monge’s syndrome
d. Gaisbocks syndrome

135. What are the abnormalities and laboratory findings observed in patient with fanconi syndrome?
a. increased osmotic fragility
b. brown skin pigmentation
c. short stature
d. all of the above

136. Which among the following correctly differentiates fanconi from Diamond-BLackfan syndrome?
a. skin pigmentation is uncommon for fanconi anemia
b. the bone marrow in diamond black-fan is observed to be hypoplastic
c. onset of hematologic abnormalities occur later in diamond-blackfan than in fanconi syndrome
d. none of the above

137. *Myelophtisic anemia involves the replacement of bone marrow cells by metastatic carcinoma
* All cases of Myelophthisic anemia are associated to a leucoerythroblastic reaction
a. both statements are true
b. both statements are false
c. only the first statement is true
d. only the second statement is

138. What is the best specimen/method used for demonstrating metastatic carcinoma in the bone marrow?
a. bone marrow aspirates
b. bone marrow biopsy (bm cellularity, overall view structure and any form of infiltrates)70-94% cases are positive
c. blood samples
d. none of the above
*however, false-negative biopsies are reported and thus it is important to also examine bone marrow aspirates (only 45% are positive)

139. Which anemia of systemic disorders is most likely associated to the presence of a burr cell?
a. anemia of endocrine disorders
b. anemia of pregnancy
c. anemia of chronic renal disease
d. all of the above
* due to accumulation of toxins and decreased release of EPO, red blood cells lyse and there is no enough bone marrow stimulation
respectively.
* burr cells are present under uremic conditions

140. What is the etiology of anemia caused by hypothyroidism?

a. thyroid hormones have inhibitory effects on EPO release
b. decreased marrow production due to diminished demand for oxygen
c. deficiency of hormones that control the thyroid, gonads and adrenals.
d. cortisol which stimulates erythropoiesis are decreased

141. All of the following are mechanisms by which anemia is observed in pregnancy, except:
a. iron deficiency
b. folate deficiency
c. bleeding at the time of delivery
d. none of the above

142. Vitamin B12 is specifically absorbed in what part of the GI tract?

a. duodenum (iron)
b. jejunum (folate)
c. ileum
d. stomach (no absorption takes place)
143. Once absorbed into the plasma, Vitamin B12 are delivered to storage sites in liver and tissues by what carrier particle?
a. TC I
b. TC II (synthesized in the liver, most important transcobalamin, deficiency of which leads to megaloblastic anemia)
c. TC III
d. IF

*TC I and III are referred as rapid proteins since they migrate faster than IF on zone electrophoresis
*IF is the carrier of vitamin B12 as it travels from stomach towards the small intestine

144. Folate found in food such as vegetables and fruits are present in what form?
a. polyglutamate
b. monoglutamate
c. methyltetrahydrofolate
d. both b and c
*polyglutamate form in food , once in the small intestine excess glutamic acid is removed to form monoglutamate (methyl
tetrahydrofolate)

145. In order to conserve the supply of polyglutamate FH4, this enzyme is needed to convert FH2 back to FH4
a. methyl transferase (homocysteine to methionine, in the presence of methylcobalamin)
b. thymidylate synthetase (FH4 to FH2 with the conversion of dUMP to thymidylate)
c. dihydrofolate reductase
d. ribonucleotide reductase (UMP conversion to dUMP)

146. The following changes in the peripheral blood are evident in cases of megaloblastic anemia:
a. macroovalocytes are present
b. neutrophil hyposegmentation is observed
c. leukopenia generally attributable to absolute lymphopenia
d. all of the above

147. Pernicious anemia is considered as the most representative form of megaloblastic anemia which may be caused by?
a. reduced or eliminated production of the intrinsic factor
b. reduction of HCL production
c. destruction of vit. B12 in the stomach
d. all of the above

148. Which among the following is not true regarding the Schilling test?
a. it is a test used to measure the body’s ability to secret IF and absorb vit. B12
b. a 24-hour urine sample collection is required
c. a physiologic dose of Co-labelled vit.B12 is injected intramuscularly
d. unlabeled B12 are also administered to saturate the liver and tissue binding sites
*labelled is given orally. Unlabeled is given intramuscularly

149. This is considered to be the leading cause of folate deficiency anemia:

a. increased requirements
b. dietary deficiency
c. alcoholic cirrhosis
d. drug inhibition
* body stores of folates are consumed faster compared with vitamin B 12 so deficiency is occurs more readily

150. Idiopathic aplastic anemia is best defined as a form of anemia that:

a. develops after a viral infection (complication from EBV or heap infection)
b. caused by a physician’s treatment (drugs used for treatment given by physician such as chloramphenicol)
c. has no identifiable cause
d. caused by anti-bacterial drugs

151. In severe folic acid deficiency, this degradation product of histidine metabolism is increased in the urine:
a. tetrahydrofolate
b. formimino-tetrahydrofolate
c. formiminoglutamic acid
d. glutamate

152. A failure to generate sufficient ATP is characteristic of red blood cells with:
a. PK deficiency
b. G-6-PD deficiency
c. lipoprotein deficiency
d. hexokinase deficiency

153. Which among the following inherited disorders in DNA synthesis is associated with pyrimidine metabolism?
a. enzyme deficiency
b. transcobalamin II defect
c. Lesh-Nyhan syndrome (lacks xanthine guanine phosphoribosyl transferase)
d. Orotic aciduria
154. This is a nuclear abnormality characterized by the inability of chromosomes to reform into a nucleus after mitosis resulting in a
disintegrated, structure less chromatin figure:
a. hypersegmentation
b. multinuclearity
c. karyorrhexis
d. none of the above

155. Among the three types of congenital dyserythropoietic anemias, what type exhibits binuclearity of cells?
a. Type I
b. Type II
c. Type III
d. both a and b

156. Type I congenital dyserythropoietic anemia has a diagnostic feature described as:
a. presence of ghost RBC that reveal irregular dark stretches of the thickened membranes (Type II)
b. multinuclearity up to 12 nucleus per cell of bone marrow normoblast (Type III)
c. Feulgen positive internuclear chromatin bridges joining two normoblast
d. both a and b

157. Which among the following is not true about Type II CDA?
a. this is also known as Hereditary Erythroblast multinuclearity with positive acidified serum test
b. Red blood cells exhibits
lysis or Serum iron Serum ferritin TIBC Transferrin saturation FEP increased sensitivity to
acidified IDA dec dec inc dec inc normal serum
c. Chronic disorder dec inc dec Normal or dec inc HEMPAS cells and PNH
cells are both Sideroblastic Inc inc dec inc mixed lysed in the sugar water
test anemia
d. Lead poisoning Inc Norm nor Inc inc Reaction of HEMPAS cell
towards Thalassemia Inc Inc N n/inc n acidified serum is
attributed to the presence of a unique antigen found on the red cell surface
(IgM antibodies bind to these antigens and activate complement cascade causing lysis)
+only PNH cells are lysed in the sugar water test differentiating the two

158. This generally is the first laboratory test to become abnormal when iron stores begin to decrease:
a. transferrin
b. ferritin (stored form of iron which only decreases in iron deficiency anemia)
c. FEP
d. TIBC

159. What sequence in the events for IDA occurs when the individual still has adequate iron stores present:
a. Iron replete
b. Iron deplete
c. Iron deficient erythropoiesis
d. Iron deficiency anemia
Replete: adequate stores are able to compensate for decreased sources
Deplete: stores are already consumed
Deficient erythropoiese: heme synthesis continues but porphyrin levels increase because of decreased iron levels
IDA: continues increase demand or loss of iron

160. Iron deficiency anemia is characterized by the following except:

a. decreased serum ferritin
b. increased FEP
c. decreased transferrin
d. decreased TIBC (since no iron is present, the capacity to bind iron increases)

161. serum ferritin is decreased only in iron deficiency anemia

Anemia of chronic disorders is characterized by increased ferritin and TIBC
a. both statements are true
b. both statements are false
c. only the first statement is true
d. only the second statements is false

162. When stained with Prussian blue, iron containing normoblasts are identified as?
 a. ringed siderocytes
b. ringed sideroblasts
c. basophilic stippling
d. Heinz bodies

163. among the three types of sideroblastic anemia, which is considered as the pathologic ringed sidereoblast?
a. Type I (ferritin aggregates only of four aggregates)
b. Type II (more than 6 ferritin aggregates are present)
c. Type III (larger granules situated in a ring or collar around the nucleus)
d. both a and b
*sideroblastic anemia is diagnosed if at least 15% of the normoblasts are of type III sideroblasts)

164. Lead poisoning is associated to abnormal heme synthesis as it affects the following enzymes involved in the process:
1- porphobilinogen deaminase 4 – uroporphyrinogen synthetase
2 – heme synthase (ferrochelatase) 5 – porphobilinogen synthase
3 – coproporphyrinogen oxidase
a. 1,4,5
b. 2, 3, 5
c. 1 and 5 only
d. 2 only

165. How is lead poisoning differentiated from acute intermittent porphyria

a. D-ALA is only increased in acute intermittent porphyria
b. In lead poisoning, both D-ALA and porphobilinogen are increased
c. porphobilinogen is increased in lead poisoning
d. D-ALA and porphobilinogen are both increased in acute intermittent porphyria
*In lead poisoning, porphobilinogen sythetase is affected leading to increased D-ALA
* In AIP, porphobilinogen deaminase is deficient and leads to an increase in both D-ALA and porphobilinogen

166. Based on the scientific designation of the hemoglobin variant shown below, which of the following choices shows a correct
interpretation?
B 6 (A3) Glu > Val
a. the 3rd amino acid of the 6th helical segment is substituted
b. 3 amino acids in the 6th helical segments of the beta chain is substituted
c. the amino acid in the 6th sequential position of the beta chain is substituted
d. 3 glutamine amino acids are substituted by valine in the beta chain
* the scientific designation is composed of the:
1. chain affected 2. Sequential amino acid number 3. Helix number involved d. abnormality type

167. This is considered as the most common form of hemoglobinopathy

a. single substitution
b. multiple substitution (ex. HbC harlem : B 6 Glu > Val;73Asp>Asn
c. amino acid deletion (ex. Hb Gun hill: deletion of 91-95 amino acid of the beta chain variant)
d. globin chain elongation (ex. Hb constant spring)

+Match the following common names of hemoglobinopathies to their scientific

designations

168. HbS c a. B 6 Glu > Lys

169. Hb C a b. B 121 Glu>Lys
170. Hb E d c. B 6 Glu > Val
171. Hb O arab b d. B 26 Glu > Lys
172. Hb G Philadelphia e e. a 68 Asn > Lys

173. When hemoglobinopathies are present the following functional abnormalities are observed:
a. cell shape distortion and hemolysis (Hb S and Hb C)
b. unstable hemoglobin precipitates (Heinz bodies formation)
c. permanent oxidation of iron (Hemoglobin M variants causing methemoglobinemia)
d. all of the above
+others: increased oxygen affinity of hemoglobin resulting to decreased affinity of oxygen towards tissues leading to cyanosis

174. This is considered as the most common cause of death in patients with sickle cell disease:
a. vaso-occlusive crisis (sickle cells increased plasma viscosity and result to thrombi formation leading to organ infarction)
b. splenic sequestration crisis (sickle cells are trapped in the spleen = splenomegaly = hypovolemia = shock)
c. infectious crisis
d. aplastic crisis (results in temporary but significant reduction in erythrocyte counts)
+infections: S. pneumoniae is the common in children. Decreased blood flow which initially occurs in the small bones of the hands and feet
(dactylitis or hand-foot syndrome). Painful swelling of the hand and feet is considered as the 1st sign of sickle cell anemia

175. In the solubility test for Hb S what reagent is used to lyse RBCs and allow Hemoglobin to escape:
a. saponin
b. sodium dithionate (provides a decreased oxygen environment)
c. sodium metabisulfite (results to decreased oxygen and sickling of cells)
 d. none of the above

176. Functionally, white blood cells are divided into:

a. granulocytes, lymphocytes
b. phagocytes and immunocytes
c. Polymorphonuclear, mononuclear
d. granulocytes and non-granulocytes
+according to function, WBCs are for defense either by phagocytosis or immune mechanisms
a. phagocytes include: granulocytes and monocytes
b. immunocyte: lymphocytes
+according to granularity
+according to nuclear segmentation

177. What is the major phagocytic cell involved in the initial defense against bacterial pathogens?
a. neutrophils
b. eosinophil
c. basophil
d. monocyte
+during bacterial infection, neutrophils are the first to respond while monocytes arrive at the site of injury after the neutrophil for the function
of cleaning up debris

178. A shift to the left, when used to describe a cell population, refers to:
a. increased cells in the blood due to a redistribution of blood pools (due to physical or emotional stimuli that is of increased WBC
count without a shift to the left)
b. an increase in immature blood cells following the release of bone marrow pools
c. a cell production hiatus (refers to the gap in normal maturation sequence: presence of blast cells and mature cells without the
intermediate stages)
d. higher percentage of lymphocyte than neutrophils
+this occurs in response to infections or tissue damage

179. The most mature granulocyte precursor that can undergo mitosis is the:
a. myeloblast
b. promyelocyte
c. myelocyte
d. metamyelocyte
+ the last stage in the granulocytic series that divides is myelocyte.

180. What is the term for cell movement through blood vessels to a tissue site?
a. diapedesis
b. opsonization
c. margination
d. chemotaxis

181. In patients with infectious mononucleosis, which blood cells are infected by the causative agent?
a. monocytes
b. T lymphocytes
c. B lymphocytes
d. Histiocytes
EBV attaches to the receptors of B lymph which generates T cell response against the infected B cells.

182. Which of the following statements about hairy cell leukemia is true?
a. It is an acute disease, primarily affecting young adults (chronic disorder affecting elderly)
b. Splenomegaly is an unusual finding (very common finding in addition to that of the hairy cell)
c. Hairy cells contain tartrate resistant acid phosphatase
d. Hairy cells are abnormal T lymphocytes (malignant B cells)

183. In which anomaly is a failure of granulocytes to divide beyond the band of two-lobed stage observed?
a. Pelger-Huet
b. May-Hegglin (dohle-like inclusions)
c. Chediak Higashi (large granules are present, photophobia and hypopigmentation)
d. none of the above
+autosomal dominant trait characterized by hyposegmentation

184. A gaucher cell is best described as a macrophage with:

a. “wrinkled cytoplasm due to an accumulation of glucocerebroside
b. foamy cytoplasm filled with unmetabolized sphingomyelin
c. Abundant cytoplasm containing storage iron and cellular remnants
d. none of the above
+gaucher is a lipid disorder where there is accumulation of glucocerebroside due to lack of enzymes(glucocerebrosidase)
b. niemann pick disease
d. normal macrophages

185. In a patient with fever of unknown origin, which of the following is not consistent with an inflammatory process?
 a. increased CRP
b. Increased albumin level
c. Increased fibrinogen level
d. Increased ESR
+Inflammation is the overall reaction of the body during infection
Negative APRs: albumin and transferrin

186. The hemorrhagic problems associated with scurvy are due to a deficiency of ___________________ which is a cofactor required for
collagen synthesis;
a. vitamin C is also associated to capillary fragility and primary hemostasis bleeding
b. Prothrombin
c. Vitamin K
d. Protein C

187. Plateles interacting with and binding to other platelets is referred to as:
a. adhesion (platelet interaction with collagen and endothelial surfaces)
b. aggregation
c. release (platelet granule contents are released)
d. Retraction (fibrin plug contracts)

188. The platelet parameter PDW refers to the Platelet distribution width which measure the uniformity of the platelet size equivalent to RDW
that measure the degree of anisocytosis)
a. average platelet volume
b. cell weight versus density
c. capacity to adhere to foreign surfaces
d. variation in platelet cell size

189. Factor IX b a. Autoprothrombin I

190. Factor VII a b. Platelet cofactor II

191. Factor VIII d c. Autoprothrombin III

192. Factor XI e d. Antihemophilic factor A

193. Factor X c e. Plasma Thromboplastin Antecedent (PTA)