Hematological test interpretation MCQs With Answer

Introduction

Understanding hematological test interpretation is essential for M.Pharm students involved in clinical pharmacy practice. This collection of focused MCQs covers common laboratory parameters—complete blood count indices, iron studies, hemolysis markers, coagulation assays, peripheral smear findings, and transfusion compatibility—emphasizing patterns and pitfalls that influence clinical decisions. Questions are designed to deepen conceptual understanding, link lab abnormalities to pathophysiology, and highlight drug- and sample-related artifacts that can mislead interpretation. Use these MCQs to reinforce diagnostic reasoning, prepare for exams, and improve communication with clinicians about laboratory-based medication management and monitoring strategies.

Q1. Which diagnosis is most likely when a patient has microcytic, hypochromic anemia with a low serum ferritin?

• Iron deficiency anemia
• Beta thalassemia trait
• Anemia of chronic disease
• Sideroblastic anemia

Correct Answer: Iron deficiency anemia

Q2. An increased red cell distribution width (RDW) with a normal mean corpuscular volume (MCV) most commonly suggests which situation?

• Early iron deficiency anemia
• Beta thalassemia trait
• Megaloblastic anemia
• Acute blood loss

Correct Answer: Early iron deficiency anemia

Q3. A markedly elevated mean corpuscular hemoglobin concentration (MCHC) is most characteristic of which condition?

• Hereditary spherocytosis
• Megaloblastic anemia
• Chronic kidney disease

Correct Answer: Hereditary spherocytosis

Q4. A rising reticulocyte count in a patient with falling hemoglobin most likely indicates which physiologic response?

• Hemolytic anemia with marrow compensation
• Aplastic anemia
• Iron deficiency without marrow response
• Chronic disease with low erythropoiesis

Correct Answer: Hemolytic anemia with marrow compensation

Q5. The combination of elevated LDH, markedly decreased haptoglobin, and increased indirect bilirubin is most consistent with which process?

• Intravascular hemolysis
• Hepatocellular injury
• Bone marrow suppression
• Sepsis-related coagulopathy

Correct Answer: Intravascular hemolysis

Q6. The presence of target cells on a peripheral blood smear most commonly suggests which diagnosis?

• Thalassemia trait
• Acute leukemoid reaction
• Vitamin B12 deficiency
• Immune thrombocytopenia

Correct Answer: Thalassemia trait

Q7. Which iron study pattern is characteristic of anemia of chronic disease (inflammatory anemia)?

• Low serum iron, low TIBC, normal or increased ferritin
• Low serum iron, high TIBC, low ferritin
• High serum iron, low TIBC, high ferritin
• High serum iron, high TIBC, low ferritin

Correct Answer: Low serum iron, low TIBC, normal or increased ferritin

Q8. Calculate transferrin saturation (TSAT) when serum iron = 40 µg/dL and TIBC = 300 µg/dL. Which value is correct?

• 13.3%
• 7.5%
• 20%
• 30%

Correct Answer: 13.3%

Q9. A prolonged prothrombin time (PT) with a normal activated partial thromboplastin time (aPTT) most strongly suggests dysfunction in which pathway or factor?

• Extrinsic pathway / vitamin K–dependent factors (e.g., warfarin effect)
• Intrinsic pathway (e.g., hemophilia A)
• Platelet function defect
• Common pathway factor deficiency (e.g., fibrinogen)

Correct Answer: Extrinsic pathway / vitamin K–dependent factors (e.g., warfarin effect)

Q10. In a patient with isolated prolonged aPTT that corrects after mixing with normal plasma, the most likely interpretation is which?

• Factor deficiency (e.g., hemophilia)
• Lupus anticoagulant inhibitor
• Disseminated intravascular coagulation
• Platelet dysfunction

Correct Answer: Factor deficiency (e.g., hemophilia)

Q11. A positive direct antiglobulin test (DAT/Coombs) with warm-reacting IgG antibodies indicates which diagnosis?

• Warm autoimmune hemolytic anemia
• Hereditary spherocytosis
• Microangiopathic hemolytic anemia
• Iron deficiency anemia

Correct Answer: Warm autoimmune hemolytic anemia

Q12. Which statement best describes the diagnostic utility of D-dimer testing for suspected venous thromboembolism (VTE)?

• High sensitivity but low specificity; useful to rule out VTE in low-risk patients
• High specificity but low sensitivity; confirms VTE when positive
• Direct measure of thrombus size
• Unaffected by recent surgery or inflammation

Correct Answer: High sensitivity but low specificity; useful to rule out VTE in low-risk patients

Q13. Between erythrocyte sedimentation rate (ESR) and C‑reactive protein (CRP), which rises and falls more quickly in acute inflammation and is more useful for monitoring short-term changes?

• CRP rises and falls more quickly than ESR
• ESR rises and falls more quickly than CRP
• Both change at the same rate
• Neither changes with acute inflammation

Correct Answer: CRP rises and falls more quickly than ESR

Q14. A platelet count reported as low on an automated analyzer but with normal platelet count on a well-prepared peripheral smear showing platelet clumps suggests which artifact?

• EDTA-induced pseudothrombocytopenia (platelet clumping)
• True immune thrombocytopenia
• Thrombotic thrombocytopenic purpura
• Heparin-induced thrombocytopenia

Correct Answer: EDTA-induced pseudothrombocytopenia (platelet clumping)

Q15. Pancytopenia with a hypocellular bone marrow biopsy is most consistent with which diagnosis?

• Aplastic anemia
• Myelofibrosis
• Acute leukemia with hypercellular marrow
• Megaloblastic anemia

Correct Answer: Aplastic anemia

Q16. A markedly elevated serum potassium in a patient with no ECG changes, normal renal function and no clinical hyperkalemia should raise suspicion for which preanalytical artifact?

• In vitro hemolysis of the sample
• Dietary potassium intake
• Chronic kidney disease
• Potassium supplementation adherence

Correct Answer: In vitro hemolysis of the sample

Q17. Hemoglobin electrophoresis showing absent HbA and predominance of HbS is diagnostic of which condition?

• Homozygous sickle cell disease (HbSS)
• Sickle cell trait (HbAS)
• Beta thalassemia trait
• Hemoglobin C trait

Correct Answer: Homozygous sickle cell disease (HbSS)

Q18. A patient has normal platelet count, prolonged bleeding time, and abnormal ristocetin cofactor assay. These findings most specifically suggest which disorder?

• von Willebrand disease
• Immune thrombocytopenic purpura
• Hemophilia B
• Bernard–Soulier syndrome

Correct Answer: von Willebrand disease

Q19. Immediate hemolysis during a transfusion with acute back pain, fever, hypotension and hemoglobinuria most likely indicates which incompatibility?

• ABO blood group incompatibility
• Minor antigen mismatch causing delayed hemolysis
• Allergic transfusion reaction to plasma proteins
• Transfusion-associated circulatory overload

Correct Answer: ABO blood group incompatibility

Q20. Marked neutrophilia with a left shift (increased band forms) on differential is most suggestive of which clinical scenario?

• Acute bacterial infection
• Viral infection such as mononucleosis
• Hypersplenism causing sequestration
• Chronic lymphocytic leukemia

Correct Answer: Acute bacterial infection

Download