Welcome to Part 42 of our Free ASCP MLS Exam Practice Questions series. This section focuses on Peripheral Blood Smear and Morphology, one of the most essential diagnostic tools in hematology. Recognizing and interpreting blood cell morphology is a fundamental skill for MLS exam success and daily laboratory practice.
🔹 Topics Covered in This Part
- Preparation and staining of peripheral smears (Wright-Giemsa, Romanowsky stains)
- Normal morphology of red blood cells, white blood cells, and platelets
- Abnormal RBC morphology (anisocytosis, poikilocytosis, schistocytes, target cells, sickle cells, etc.)
- Abnormal WBC morphology (toxic granulation, Auer rods, blasts, Pelger-Huët anomaly)
- Platelet morphology and associated disorders
- Correlation of morphology with disease states (anemias, leukemias, infections, etc.)
60 MCQs (3461 – 3520):
📘 How to Use These Practice Questions
- The questions in this section are designed to test your ability to identify and interpret blood smear findings.
- Numbering continues from the previous article — starting at Question 3461.
- Each question set will be followed by an answer key with explanations for effective self-assessment.
- Which stain is routinely used to examine peripheral blood smears?
a) Wright–Giemsa stain
b) Prussian blue stain
c) PAS stain
d) Sudan black stain - Microcytosis on a peripheral smear is typically seen in:
a) Iron deficiency anemia
b) Megaloblastic anemia
c) Aplastic anemia
d) Hemolytic anemia - Macro-ovalocytes are most characteristic of:
a) Sickle cell anemia
b) Megaloblastic anemia
c) Thalassemia
d) Sideroblastic anemia - Target cells are most commonly seen in:
a) Thalassemia and liver disease
b) Iron deficiency anemia
c) Aplastic anemia
d) Sickle cell anemia only - Spherocytes are typically seen in:
a) Hereditary spherocytosis and autoimmune hemolysis
b) Iron deficiency anemia
c) Thalassemia minor
d) Megaloblastic anemia - Schistocytes (fragmented RBCs) are commonly associated with:
a) Hemolytic uremic syndrome and DIC
b) Iron deficiency anemia
c) Aplastic anemia
d) Megaloblastic anemia - Howell–Jolly bodies represent:
a) RNA remnants
b) DNA remnants
c) Iron deposits
d) Denatured hemoglobin - Basophilic stippling is most often associated with:
a) Lead poisoning
b) Iron deficiency anemia
c) G6PD deficiency
d) Hemolysis - Heinz bodies are best visualized with:
a) Wright stain
b) Supravital stain
c) Prussian blue
d) PAS stain - Bite cells are most associated with:
a) Iron deficiency anemia
b) G6PD deficiency
c) Aplastic anemia
d) Pernicious anemia - Rouleaux formation of RBCs is commonly seen in:
a) Multiple myeloma
b) Hemolysis
c) Thalassemia
d) Sickle cell anemia - Teardrop-shaped RBCs (dacrocytes) are seen in:
a) Myelofibrosis
b) Iron deficiency anemia
c) Aplastic anemia
d) Sickle cell anemia - Hypersegmented neutrophils are associated with:
a) Megaloblastic anemia
b) Hemolytic anemia
c) Thalassemia minor
d) Polycythemia vera - Hyposegmented neutrophils (Pelger–Huët anomaly) are typically:
a) Acquired from B12 deficiency
b) Inherited benign anomaly
c) Seen in iron deficiency
d) Pathognomonic for leukemia only - Toxic granulation in neutrophils is commonly seen in:
a) Viral infections
b) Severe bacterial infections
c) Megaloblastic anemia
d) Thalassemia - Atypical lymphocytes are most often associated with:
a) Mononucleosis (EBV infection)
b) Bacterial sepsis
c) Leukemia only
d) Iron deficiency anemia - Giant platelets are most characteristic of:
a) Bernard–Soulier syndrome
b) Aplastic anemia
c) Polycythemia vera
d) Iron deficiency anemia - The presence of nucleated RBCs (normoblasts) in peripheral blood may indicate:
a) Hemolysis or bone marrow stress
b) Vitamin B12 deficiency
c) Iron deficiency anemia
d) Aplastic anemia - Pappenheimer bodies represent:
a) DNA remnants
b) Iron granules
c) RNA granules
d) Hemoglobin crystals - Cabot rings in RBCs are associated with:
a) Pernicious anemia
b) Lead poisoning
c) Malaria
d) Sickle cell disease - Auer rods are found in:
a) Lymphoblasts
b) Myeloblasts
c) Megakaryocytes
d) Plasma cells - Smudge cells are characteristic of:
a) CLL
b) AML
c) ALL
d) Hodgkin lymphoma - Which RBC morphology is typical of liver disease?
a) Target cells and acanthocytes
b) Schistocytes
c) Bite cells
d) Hypersegmented neutrophils - Which infection can cause ring forms inside RBCs?
a) Malaria
b) EBV
c) HIV
d) CMV - Echinocytes (burr cells) are associated with:
a) Uremia
b) Iron deficiency anemia
c) G6PD deficiency
d) Malaria - Acanthocytes (spur cells) are typically associated with:
a) Liver disease and abetalipoproteinemia
b) Renal disease
c) Megaloblastic anemia
d) Lead poisoning - Stomatocytes are associated with:
a) Alcoholism and liver disease
b) Iron deficiency anemia
c) G6PD deficiency
d) Aplastic anemia - Which WBC morphology is characteristic of “hairy cell leukemia”?
a) Cells with hairy cytoplasmic projections
b) Cells with large nucleoli only
c) Lymphocytes with smudge appearance
d) Neutrophils with toxic granules - Leukemoid reaction can mimic leukemia but is distinguished by:
a) High LAP score
b) Low LAP score
c) Presence of blasts
d) Smudge cells - Hypogranular neutrophils are commonly seen in:
a) Myelodysplastic syndromes
b) Iron deficiency anemia
c) Polycythemia vera
d) Viral infections - On a Wright-stained peripheral blood smear, a red blood cell that is small, spherical, and lacks central pallor is identified as a:
a) Leptocyte
b) Spherocyte
c) Codocyte
d) Dacrocyte - Which of the following red blood cell inclusions represents residual nuclear DNA?
a) Pappenheimer bodies
b) Heinz bodies
c) Howell-Jolly bodies
d) Basophilic stippling - The presence of excessive rouleaux formation on a blood smear is often associated with an increased:
a) Reticulocyte count
b) Erythrocyte sedimentation rate (ESR)
c) Hematocrit
d) Erythrocyte count - Which of the following RBC inclusions are composed of iron and can be confirmed with a Prussian blue stain?
a) Cabot rings
b) Heinz bodies
c) Pappenheimer bodies
d) Howell-Jolly bodies - A Wright-stained peripheral blood smear reveals blue, ring-shaped inclusions with red chromatin dots. These are most consistent with:
a) Malarial parasites (Plasmodium falciparum)
b) Howell-Jolly bodies
c) Cabot rings
d) Basophilic stippling - The term “shift to the left” refers to the presence of:
a) A calibration adjustment on an instrument
b) Immature granulocyte forms in the peripheral blood
c) A trend on a Levy-Jennings chart
d) A microscope adjustment - Döhle bodies in the cytoplasm of neutrophils are composed of:
a) Denatured hemoglobin
b) Aggregated ribosomes (rough endoplasmic reticulum)
c) Precipitated DNA
d) Iron particles - Which of the following cells is characterized by an eccentric nucleus, deep blue cytoplasm, and a prominent perinuclear hof (Golgi area)?
a) Reactive lymphocyte
b) Plasma cell
c) Monocyte
d) Myelocyte - The presence of many microspherocytes and schistocytes on a peripheral blood smear is most suggestive of:
a) Hereditary spherocytosis
b) Thalassemia major
c) Extensive burns
d) Iron deficiency anemia - If a blood smear is dried too slowly, the red blood cells often appear:
a) Lysed
b) Crenated
c) Agglutinated
d) Spherocytic - The specimen of choice for preparing blood films for a manual differential leukocyte count is whole blood collected in:
a) Heparin
b) Sodium citrate
c) Potassium oxalate
d) EDTA - A nucleated red blood cell with a round, pyknotic nucleus and abundant, pinkish-gray cytoplasm is classified as a(n):
a) Basophilic normoblast
b) Polychromatophilic normoblast
c) Orthochromatic normoblast
d) Pronormoblast - The large, reactive lymphocytes seen in infectious mononucleosis are derived primarily from which cell type?
a) B lymphocytes
b) T lymphocytes
c) Monocytes
d) NK cells - Which area on a Sysmex scattergram (DIFF plot) typically represents the neutrophil population?
a) High side scatter, low side fluorescence
b) Low side scatter, high side fluorescence
c) Low side scatter, low side fluorescence
d) High side scatter, high side fluorescence - On a Siemens Advia scattergram (Perox channel), the area labeled “6” typically represents which cell population?
a) Lymphocytes
b) Monocytes
c) Neutrophils
d) Eosinophils - Cabot rings, which are red or purple ring-shaped inclusions, are believed to be remnants of:
a) Nuclear material
b) Mitochondria
c) Mitotic spindle fibers
d) Denatured hemoglobin - The presence of nucleated red blood cells and polychromasia on a peripheral blood smear is evidence of:
a) Hemolytic anemia
b) Active red cell regeneration
c) Megaloblastic anemia
d) Iron deficiency - Which of the following is the best description of a reactive lymphocyte?
a) Small size, clumped chromatin, scanty cytoplasm
b) Large size, irregular nucleus, abundant blue cytoplasm
c) Large size, round nucleus, granular cytoplasm
d) Small size, nucleoli, pale blue cytoplasm - A manual platelet estimate is performed by counting the average number of platelets per oil immersion field (100x) and multiplying by:
a) 1,000
b) 10,000
c) 15,000
d) 20,000 - The red cell distribution width (RDW) is a quantitative measure of:
a) Hemoglobin concentration
b) Red cell size variation (anisocytosis)
c) Red cell shape variation (poikilocytosis)
d) Mean red cell volume - Which of the following white blood cells is typically the largest under normal conditions?
a) Neutrophil
b) Lymphocyte
c) Monocyte
d) Eosinophil - A neutrophil with six or more nuclear lobes is defined as:
a) Hypersegmented
b) A Pelger-Huët cell
c) A smudge cell
d) A reactive cell - The characteristic peripheral blood morphologic feature in multiple myeloma is:
a) Spherocytosis
b) Toxic granulation
c) Rouleaux formation
d) Macro-ovalocytes - A cell described as having a kidney-shaped nucleus, lacy chromatin, and abundant gray-blue cytoplasm with fine azurophilic granules is a:
a) Promyelocyte
b) Monocyte
c) Myelocyte
d) Reactive lymphocyte - Teardrop cells (dacrocytes) and abnormal platelet forms are most characteristically seen in:
a) Hemolytic anemia
b) G6PD deficiency
c) Primary myelofibrosis
d) Multiple myeloma - On a Wright-stained smear, basophilic stippling appears as:
a) Large, blue cytoplasmic inclusions
b) Small, red granules throughout the RBC
c) Small, blue-purple granules evenly distributed in the RBC
d) Ring-like structures on the RBC membrane - A flag for “immature granulocytes” on an automated hematology analyzer should be followed up by performing a:
a) Reticulocyte count
b) Smear review and manual differential
c) Pathologist review
d) Repeat analysis on a warmed specimen - A mature basophil on a peripheral blood smear is characterized by:
a) A bilobed nucleus obscured by large, blue-black granules
b) A segmented nucleus with large, orange-red granules
c) A round nucleus with no visible granules
d) A horseshoe-shaped nucleus with fine pink granules - The presence of schistocytes on a peripheral blood smear is indicative of:
a) Liver disease
b) Megaloblastic anemia
c) Microangiopathic hemolytic anemia
d) Hemoglobinopathy - Which of the following is an artifact that can occur if a blood smear is made from an EDTA sample that is more than 5 hours old?
a) Spherocytosis
b) Crenation
c) Platelet satellitism
d) Rouleaux formation
📌 How to Use This Practice Set
- Answer each question before checking the key.
- Focus on why the correct answer is right and the others are wrong.
- Use this set as timed practice to simulate the real exam environment.
Answer Key
Answer Key:
- a) Wright–Giemsa stain
- a) Iron deficiency anemia
- b) Megaloblastic anemia
- a) Thalassemia and liver disease
- a) Hereditary spherocytosis and autoimmune hemolysis
- a) Hemolytic uremic syndrome and DIC
- b) DNA remnants
- a) Lead poisoning
- b) Supravital stain
- b) G6PD deficiency
- a) Multiple myeloma
- a) Myelofibrosis
- a) Megaloblastic anemia
- b) Inherited benign anomaly
- b) Severe bacterial infections
- a) Mononucleosis (EBV infection)
- a) Bernard–Soulier syndrome
- a) Hemolysis or bone marrow stress
- b) Iron granules
- a) Pernicious anemia
- b) Myeloblasts
- a) CLL
- a) Target cells and acanthocytes
- a) Malaria
- a) Uremia
- a) Liver disease and abetalipoproteinemia
- a) Alcoholism and liver disease
- a) Cells with hairy cytoplasmic projections
- a) High LAP score
- a) Myelodysplastic syndromes
- b) Spherocyte
- c) Howell-Jolly bodies
- b) Erythrocyte sedimentation rate (ESR)
- c) Pappenheimer bodies
- a) Malarial parasites (Plasmodium falciparum)
- b) Immature granulocyte forms in the peripheral blood
- b) Aggregated ribosomes (rough endoplasmic reticulum)
- b) Plasma cell
- c) Extensive burns
- b) Crenated
- d) EDTA
- c) Orthochromatic normoblast
- b) T lymphocytes
- a) High side scatter, low side fluorescence
- d) Eosinophils
- c) Mitotic spindle fibers
- b) Active red cell regeneration
- b) Large size, irregular nucleus, abundant blue cytoplasm
- d) 20,000
- b) Red cell size variation (anisocytosis)
- c) Monocyte
- a) Hypersegmented
- c) Rouleaux formation
- b) Monocyte
- c) Primary myelofibrosis
- c) Small, blue-purple granules evenly distributed in the RBC
- b) Smear review and manual differential
- a) A bilobed nucleus obscured by large, blue-black granules
- c) Microangiopathic hemolytic anemia
- b) Crenation
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