Blood smear morphology, anaemias and leukaemias

70 Lab technician recruitment practice questions on Blood smear morphology, anaemias and leukaemias, part of Haematology. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

1. Question 1 · Medium

   A shift to the left in a blood film means:

   1. AMore hypersegmented neutrophils
   2. BMore band forms and young neutrophils
   3. CMore lymphocytes than neutrophils
   4. DFewer platelets than normal

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   Answer: B · More band forms and young neutrophils

   A left shift is an increase in less mature neutrophils (bands, metamyelocytes, myelocytes). It is seen in acute bacterial infection and in leukaemoid reactions, often with toxic granulation.

   • A: Hypersegmented neutrophils are called a shift to the right.
   • C: Relative lymphocytosis is a different finding.
   • D: Platelet number is not part of the shift.

2. Question 2 · Medium

   Under NVBDCP, malaria parasite density in a thick smear is reported against:

   1. A10 oil-immersion fields only
   2. B200 white cells
   3. C100 red cells
   4. D1000 platelets

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   Answer: B · 200 white cells

   Parasites are counted against 200 white cells in the thick smear (500 if few parasites are seen), and the density per µL is calculated using the patient's WBC count or an assumed 8,000/µL.

   • A: Field counts are only a rough grading.
   • C: Counting per 100 red cells is done on the thin smear for percentage parasitaemia.
   • D: Platelets are not used for parasite counts.

3. Question 3 · Easy

   What is the usual pH of the buffered water used with Leishman stain for routine blood films?

   1. A7.8
   2. B6.8
   3. C5.4
   4. D8.6

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   Answer: B · 6.8

   Buffered water at pH 6.8 gives the balanced staining of a good blood film: pink red cells, purple nuclei and lilac neutrophil granules. For malaria parasites with Giemsa, pH 7.2 is preferred to show Schuffner's dots.

   • A: Too alkaline a pH makes the film blue and red cells grey-green.
   • C: An acid pH makes the film too red and nuclei pale.
   • D: This is far too alkaline and would give a blue film.

4. Question 4 · Easy

   Heinz bodies are made of:

   1. ARibosomal RNA
   2. BNuclear DNA
   3. CDenatured haemoglobin
   4. DIron granules

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   Answer: C · Denatured haemoglobin

   Heinz bodies are precipitated oxidized haemoglobin attached to the membrane. They are shown with a supravital stain such as crystal violet and are seen in G6PD deficiency after oxidant stress and with unstable haemoglobins.

   • A: Ribosomal RNA forms reticulocyte networks and basophilic stippling.
   • B: Nuclear DNA forms Howell-Jolly bodies.
   • D: Iron granules are Pappenheimer bodies or siderotic granules.

5. Question 5 · Easy

   Which red cell inclusion consists of nuclear remnants (DNA)?

   1. ACabot ring
   2. BPappenheimer body
   3. CHowell-Jolly body
   4. DHeinz body

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   Answer: C · Howell-Jolly body

   Howell-Jolly bodies are small round dense purple nuclear fragments, usually one per cell. They are typical after splenectomy and in hyposplenism, and in megaloblastic anaemia.

   • A: Cabot rings are thought to be remnants of the mitotic spindle, not DNA fragments.
   • B: Pappenheimer bodies contain iron.
   • D: Heinz bodies are denatured haemoglobin seen with supravital stains.

6. Question 6 · Medium

   Why is the differential count done in the area near the tail where red cells just touch?

   1. APlatelets are absent there
   2. BCells are spread flat and evenly there
   3. CCells there are freshly stained
   4. DOnly neutrophils collect there

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7. Question 7 · Medium

   Helmet cells and triangular red cell fragments seen together with low platelets are most suggestive of:

   1. AIron deficiency anaemia
   2. BAplastic anaemia
   3. CMicroangiopathic haemolytic anaemia
   4. DHereditary spherocytosis

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8. Question 8 · Easy

   Red cells that are smaller and paler than normal are described as:

   1. AMicrocytic hypochromic
   2. BMicrocytic hyperchromic
   3. CNormocytic normochromic
   4. DMacrocytic normochromic

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9. Question 9 · Easy

   Sickle cells in a blood film are due to polymerization of:

   1. AHaemoglobin A2 in the cytoplasm
   2. BHaemoglobin S when deoxygenated
   3. CSpectrin in the membrane
   4. DHaemoglobin F when oxygenated

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10. Question 10 · Medium

    Polychromasia in a Leishman film corresponds to which cells in a supravital stain?

    1. AReticulocytes
    2. BSpherocytes
    3. CTarget cells
    4. DSickle cells

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11. Question 11 · Medium

    Reactive (atypical) lymphocytes with abundant blue cytoplasm indenting around red cells are typical of:

    1. AChronic lymphocytic leukaemia
    2. BAplastic anaemia
    3. CIron deficiency
    4. DInfectious mononucleosis

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12. Question 12 · Hard

    A corrected reticulocyte count is 4% with haematocrit 25%, for which the maturation time in blood is taken as 2 days. The reticulocyte production index is:

    1. A8
    2. B4
    3. C1
    4. D2

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13. Question 13 · Medium

    Which of these confirms that granules in a red cell are Pappenheimer bodies?

    1. AThey stain blue with Perls' stain
    2. BThey disappear after Leishman staining
    3. CThey stain blue with new methylene blue only
    4. DThey are larger than the red cell nucleus

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14. Question 14 · Easy

    Smudge (basket) cells in large numbers are typical of:

    1. AChronic lymphocytic leukaemia
    2. BMalaria
    3. CIron deficiency anaemia
    4. DChronic myeloid leukaemia

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15. Question 15 · Medium

    All of the following are seen in hyposplenism EXCEPT:

    1. AHypersegmented neutrophils
    2. BHowell-Jolly bodies
    3. CTarget cells
    4. DPappenheimer bodies

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16. Question 16 · Hard

    A Leishman film shows clumps of platelets at the tail and the analyser reports a platelet count of 40,000/µL in a well patient without bleeding. The next step is:

    1. ARepeat the count on a citrated sample
    2. BAsk for a bone marrow examination
    3. CReport severe thrombocytopenia urgently
    4. DRepeat on the same EDTA tube after mixing

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17. Question 17 · Medium

    Leukaemic hiatus means:

    1. ABlasts and mature cells with few intermediate forms
    2. BAbsence of all white cells
    3. CLymphocytes replacing neutrophils
    4. DEqual numbers of all myeloid stages

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18. Question 18 · Medium

    From a differential showing 60% segmented forms and an analyser total of 10,000/µL, the absolute neutrophil count works out as:

    1. A60,000/µL
    2. B6,000/µL
    3. C600/µL
    4. D4,000/µL

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19. Question 19 · Easy

    The Philadelphia chromosome is the hallmark of:

    1. AMultiple myeloma
    2. BHairy cell leukaemia
    3. CChronic myeloid leukaemia
    4. DChronic lymphocytic leukaemia

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20. Question 20 · Easy

    Thin cigar-shaped red cells scattered among pale microcytes on a Leishman film point to:

    1. ALead poisoning
    2. BSickle cell disease
    3. CIron deficiency anaemia
    4. DMegaloblastic anaemia

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21. Question 21 · Medium

    Tear-drop cells (dacrocytes) with leucoerythroblastic picture suggest:

    1. AThalassaemia trait
    2. BAcute blood loss
    3. CMyelofibrosis
    4. DIron deficiency

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22. Question 22 · Medium

    Band-form trophozoites across the red cell and rosette schizonts with about 8 merozoites are seen in:

    1. APlasmodium malariae
    2. BBabesia microti
    3. CPlasmodium vivax
    4. DPlasmodium falciparum

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23. Question 23 · Easy

    Romanowsky stains such as Leishman and Giemsa are made of:

    1. AEosin and methylene blue products
    2. BCarbol fuchsin and malachite green
    3. CCrystal violet and safranin
    4. DHaematoxylin and eosin

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24. Question 24 · Easy

    Hypersegmented neutrophils are a feature of:

    1. AAcute blood loss
    2. BMegaloblastic anaemia
    3. CHaemolytic anaemia
    4. DIron deficiency anaemia

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25. Question 25 · Medium

    In aplastic anaemia the blood and marrow typically show:

    1. ARaised reticulocytes and spherocytes
    2. BPancytopenia with low reticulocytes and fatty marrow
    3. CPancytopenia with many blasts
    4. DMicrocytes with a cellular marrow

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