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Hematology 1 Practice Exam Samplex (Prelim-Finals)
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CLINICAL HEMATOLOGY SAMPLEX
1.
The normal sequence of blood cell development is
A. Yolk sac --- red bone marrow --- liver and spleen
B. Yolk sac --- thymus --- liver and spleen --- red bone
marrow
C. Yolk sac --- liver and spleen --- red bone marrow
D. Liver and spleen --- yolk sac --- red bone marrow
2.
The maturational sequence of the thrombocyte (platelet) is
A. Megakaryoblast --- promegakaryocyte --megakaryocyte --- thrombocyte
B. Promegakaryocyte --- megakaryocyte ---metamegakaryocyte ---- thrombocyte
C. Megakaryoblast --- promegakaryocyte --megakaryocyte --- thrombocyte
D. Megakaryoblast --- promegakaryocyte --metamegakaryocyte --- thrombocyte
3.
4.
5.
6.
The maturational sequence of the erythrocyte is
A. Rubriblast --- prorubricyte --- rubricyte --- metarubricyte
--- reticulocyte --- mature erythrocyte
B. Prorubricyte --- rubricyte --- metarubricyte --reticulocyte --- mature erythrocyte
C. Pronormoblast --- basophilic normoblast --polychromatophilic normoblast --- orthochromic
normoblast --- reticulocyte --- mature erythrocyte
D. Both A and C
The cell maturation sequence of the segmented neutrophil si
A. Promyelocyte --- myeloblast --- myelocyte --metamyelocyte --- band or stab --- segmented
neutrophil (PMN)
B. Myeloblast --- promyelocyte --- myelocyte --metamyelocyte --- band or stab --- segmented
neutrophil (PMN)
C. Monoblast --- promyelocyte --- myelocyte --metamyelocyte --- band or stab --- segmented
neutrophil (PMN)
D. Promyelocyte --- myelocyte --- metamyelocyte --- band
or stab --- segmented neutrophil (PMN)
As a blood cells matures, the overall cell diameter in most
cases
A. Increases
B. Decreases
C. Remains the same
As a blood cell matures, the ratio of nucleus to cytoplasm
(N:C) in most cases
A. Increases
B. Decreases
C. Remains the same
7.
The chromatin pattern, in most cells, as the cell matures
A. Becomes more clumped
B. Becomes less clumped
C. Remains the same
8.
The presence of nucleoli is associated with
A. Immature cells
B. All young cells, except myeloblasts
C. Only erythroblasts
D. Disintegrating cells
9.
In the blast stage of development of leukocytes, the
cytoplasm of the cell is
A. Dark blue and lacks vacuoles
B. Light blue and lacks granules
C. Light blue and has specific granules
D. Gray with many dark blue granules
10. The progression of erythropoiesis from prenatal life to
adulthood is
A. yolk sac—red bone marrow—liver and spleen
B. yolk sac—liver and spleen—red bone marrow
C. red bone marrow—liver and spleen—yolk sac
D. liver and spleen—yolk sac—red bone marrow
11. Which of the following is (are) characteristic(s) of
erythropoietin?
A. Glycoprotein
B. Secreted by the liver
C. Secreted by the kidneys
D. All of the above
12. Which of the following is a characteristic of erythropoietin?
A. Produced primarily in the liver of the unborn
B. Gene for erythropoietin is found on chromosome 11
C. Most erythropoietin is secreted by the liver in adults
D. Cannot cross the placental barrier
13. Stimulation of erythropoietin is caused by
A. tissue hypoxia
B. hypervolemia
C. inflammation
D. infection
14. The maturational sequences of an erythrocyte are
A. rubriblast—prorubricyte—metarubricyte—rubricytereticulocyte
B. rubriblast—prorubricyte—rubricyte—metarubricytereticulocyte
C. pronormoblast—basophilic normoblast—polychro-matic
normoblast—orthochromatic normoblast—reticulocyte
D. both B and C
15. What is the immature erythrocyte found in the bone marrow
with the following characteristics: 12 to 17mm in diameter,
N:C of 4:1, nucleoli not usually apparent, and basophilic
cytoplasm?
A. Rubriblast (pronormoblast)
B. Reticulocyte
C. Metarubricyte (orthochromatic normoblast)
D. Prorubricyte (basophilic normoblast)
16. The nucleated erythrocyte with a reddish pink cytoplasm and
condensed chromatin pattern is a
A. rubricyte (polychromatic normoblast)
B. basophilic normoblast (prorubricyte)
C. metarubricyte (orthochromatic normoblast)
D. either B or C
17. With a normal diet, an erythrocyte remains in the reticulocyte
stage in the circulating blood for
A. 1 day
B. 2.5 days
C. 3 days
D. 120 days
18. In a Wright-stained peripheral blood film, the reticulocyte will
have a blue appearance. This is referred to as
A. megaloblastic maturation
B. bluemia
C. polychromatophilia
D. erythroblastosis
19. In the reticulocyte stage of erythrocytic development,
A. nuclear chromatin becomes more condensed
B. RNA is catabolized and ribosomes disintegrate
C. full hemoglobinization of the cell occurs
D. both B and C
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20. On a Wright-stained peripheral blood smear, stress or shift
reticulocytes are
A. smaller than normal reticulocytes
B. about the same size as normal reticulocytes
C. larger than normal reticulocytes
D. noticeable because of a decreased blue tint
21. The normal range for reticulocytes in adults is
A. 0% to 0.5%
B. 0.5% to 1.0%
C. 0.5% to 2.0%
D. 1.5% to 2.5%
22. If a male patient has a reticulocyte count of 5.0% and a
packed cell volume of 0.45 L/L, what is his corrected
reticulocyte count?
A. 2.5%
B. 4.5%
C. 5.0%
D. 10%
23. If a male patient has a reticulocyte count of 6.0% and a
packed cell volume of 45%, what is his RPI?
A. 1.5
B. 3.0
C. 4.5
D. 6.0
24. Normal adult hemoglobin has
A. two alpha and two delta chains
B. three alpha and one beta chains
C. two alpha and two beta chains
D. two beta and two epsilon chains
25. The number of heme groups in a hemoglobin molecule is
A. 1
B. 2
C. 3
D. 4
31
31. _____
A. Liver
B. Spleen
C. red bone marrow
D. mitochondria
32. _____
A. iron
B. vitamin B6
C. vitamin B12
D. vitamin D
33. The final steps in heme synthesis, including the formation of
protoporphyrin, take place in
A. a cell’s nucleus
B. a cell’s cytoplasm
C. the spleen
D. the mitochondria
34. An acquired disorder of heme synthesis is
A. congenital erythropoietic porphyria
B. lead poisoning
C. hemolytic anemia
D. hemoglobinopathy
35. The protein responsible for the transport of iron in
hemoglobin synthesis is
A. globin
B. transferrin
C. oxyhemoglobin
D. ferritin
Questions 36 and 38: If globin synthesis is insufficient in a person, iron
accumulates in the cell’s (27) _____ as (28) _____ aggregates
36.
_____
A. Nucleus
B. Cytoplasm
C. Golgi apparatus
D. Mitochondria
37.
_____
A. transferrin
B. ferritin
C. albumin
D. iron
26. Increased amounts of 2,3-DPG _____ the oxygen affinity of
the hemoglobin molecule
A. Increases
B. decreases
C. does not alter
27. After a molecule of hemoglobin gains the first two oxygen
molecules, the molecule
A. expels 2,3-DPG
B. has decreased oxygen affinity
C. becomes saturated with oxygen
D. adds a molecule of oxygen to an alpha chain
28. If normal adult (A1) and fetal hemoglobin F are compared,
fetal hemoglobin has _____ affinity for oxygen
A. less
B. the same
C. a greater
29. Oxyhemoglobin is a _____ than deoxyhemoglobin.
A. weaker acid
B. stronger acid
30. Heme is synthesized predominantly in the
A. Liver
B. red bone marrow
C. mature erythrocytes
D. both A and B
– 32. The initial condensation reaction in the synthesis of
porphyrin preceding heme formation takes place in the (22)
_____ and requires (23) _____
38. Increased erythropoietin production in secondary
polycythemia can be caused by
A. chronic lung disease
B. smoking
C. renal neoplasms
D. all of the above
39. Relative polycythemia exists when
A. increased erythropoietin is produced
B. the total blood volume is expanded
C. the plasma volume is increased
D. the plasma volume is decreased
40. Which of the following is (are) characteristic(s) of
megaloblastic maturation?
A. Cells of some leukocytic cell lines are smaller than
normal
B. Nuclear maturation lags behind cytoplasmic maturation
C. Cytoplasmic maturation lags behind nuclear maturation
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D.
Erythrocytes are smaller than normal
Questions 41 and 42: When porphyrin synthesis is impaired, the (32)
_____ become encrusted with (33) _____
41.
_____
A. Lysosomes
B. Nucleoli
C. Mitochondria
D. Vacuoles
42. _____
A. protoporphyrin
B. hemoglobin
C. iron
D. delta-aminolevulinic acid
43. Which of the following hemoglobin types is the major type
present in a normal adult?
A. A
B. S
C. A2
D. Bart
44. The alkaline denaturation test detects the presence of
hemoglobin
A. A1C
B. F
C. C
D. S
Questions 45 through 48: Match the following hemoglobin types
45. _____ A
46. _____ A2
47. _____ F
48. _____ Embryonic
A.
B.
C.
D.
Two alpha and two delta chains
Zeta chains and either epsilon or gamma chains
Two alpha and two beta chains
Two alpha and two gamma chains
49. Fetal hemoglobin (hemoglobin F) persists until
A. a few days after birth
B. a few weeks after birth
C. several months after birth
D. adulthood
50. Cellulose acetate at pH 8.6 separates the hemoglobin
fractions
A. S
B. H
C. A
D. both A and C
51. If an alkaline (pH 8.6) electrophoresis is performed,
hemoglobin E has the same mobility as hemoglobin
A. S
B. F
C. A
D. C
52. The limited metabolic ability of erythrocytes is owing to
A. the absence of RNA
B. the absence of ribosomes
C. no mitochondria for oxidative metabolism
D. the absence of DNA
53. Which of the following statements is (are) true of the
erythrocytic cytoplasmic contents?
A. High in potassium ion
B. High in sodium ion
C. Contain glucose and enzymes necessary for glycolysis
D. Both A and C
54. The Embden-Meyerhof glycolytic pathway uses _____% of
the erythrocyte’s total glucose
A. 10
B. 20
C. 50
D. 90
55. The Embden-Meyerhof pathway net gain of ATP provides
high energy phosphates to
A. maintain membrane lipids
B. power the cation pump needed for the sodiumpotassium concentration pump and calcium fl ux
C. preserve the shape and flexibility of the cellular
membrane
D. all of the above
56. The end product of the Embden-Meyerhof pathway of
glucose metabolism in the erythrocyte is
A. pyruvate
B. lactate
C. glucose-6-phosphate
D. the trioses
57. The net gain in ATPs in the Embden-Meyerhof glycolytic
pathway is
A. 1
B. 2
C. 4
D. 6
58. The most common erythrocytic enzyme deficiency involving
the Embden-Meyerhof glycolytic pathway is a deficiency of
A. ATPase
B. pyruvate kinase
C. glucose-6-phosphate dehydrogenase
D. lactic dehydrogenase
59. If a defect in the oxidative pathway (hexose monophosphate
shunt) occurs, what will result?
A. Insufficient amounts of reduced glutathione
B. Denaturation of globin
C. Precipitation of Heinz bodies
D. All of the above
60. The function of the methemoglobin reductase pathway is to
A. prevent oxidation of heme iron
B. produce methemoglobinemia
C. provide cellular energy
D. control the rate of glycolysis
61. The Luebering-Rapoport pathway
A. permits the accumulation of 2,3-DPG
B. promotes glycolysis
C. produces cellular energy
D. produces acidosis
62. In conditions of acidosis,
A. erythrocytic glycolysis is reduced
B. available oxygen is increased
C. DPG levels fall to a level sufficient to normalize oxygen
tension
D. all of the above
63. As the erythrocyte ages,
A. the membrane becomes less flexible with loss of cell
membrane
B. cellular hemoglobin increases
C. enzyme activity, particularly glycolysis, decreases
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D.
all of the above
B.
C.
D.
64. Erythrocytic catabolism produces the disassembling of
hemoglobin followed by
A. iron transported in the plasma by transferrin
B. globin catabolized in the liver to amino acids and then
entering the amino acid pool
C. bilirubin formed from opened porphyrin ring and carried
by plasma albumin to the liver, conjugated, and
excreted in bile
D. all of the above
65. Which of the following statements are true of the
intravascular destruction of erythrocytes?
A. It accounts for less than 10% of normal erythrocyte
breakdown
B. Hemoglobin is released directly into blood
C. Alpha and beta dimers are bound to haptoglobin
D. All of the above
66. The upper limit of the reference range of hemoglobin in an
adult male is
A. 10.5 to 12.0 g/Dl
B. 12.5 to 14.0 g/dL
C. 13.5 to 15.0 g/dL
D. 14 to 18.0 g/dL
Questions 67 through 69: Match the specific erythrocytic indices with
the appropriate formula
67. _____ MCV
68. _____ MCH
69. _____ MCHC
A.
B.
C.
Packed cell volume or hematocrit (in L/L)/erythrocyte
count (×1012 /L) = Fl
Hemoglobin (in g/dL)/packed cell volume or hematocrit
(in L/L) = g/dL
Hemoglobin (×10 g/dL)/erythrocyte count (×1012/L) =
pg
Questions 70 through 72: Match the erythrocytic indices with the
appropriate normal value
76. The best source of active bone marrow from a 20 year old
would be:
A. Iliac crest
B. Femur
C. Distal radius
D. Tibia
77. Physiologic programmed cell death is termed:
A. Angiogenesis
B. Apoptosis
C. Aneurysm
D. Apohematics
78. Which organ is the site of sequestration of platelets?
A. Liver
B. Thymus
C. Spleen
D. Bone marrow
79. Which one of the following morphologic changes occurs
during normal blood cell maturation?
A. Increase in cell diameter
B. Development of cytoplasm basophilia
C. Condensation of nuclear chromatin
D. Appearance of nucleoli
80. Which one of the following cells is a product of the common
lymphoid progenitor?
A. Megakaryocyte
B. T lymphocyte
C. Erythrocyte
D. Granulocyte
81. What growth factor is produced in the kidneys and is used to
treat anemia associated with kidney disease?
A. EPO
B. TPO
C. G-CSF
D. KIT Ligand
82. Which one of the following cytokines is required very early in
the differentiation of a hematopoietic stem cell?
A. IL-2
B. IL-8
C. EPO
D. FLT3 ligand
70. _____ MCV
71. _____ MCH
72. _____ MCHC
A.
B.
C.
Liver
Thymus
Bone marrow
32 to 36 g/Dl
27 to 32 pg
80 to 96 fL
73. The process of formation and development of blood cells is
termed:
A. Hematopoiesis
B. Hematemesis
C. Hematocytometer
D. Hematorrhea
74. During the second trimester of fetal development, the
primary site of blood cell production is the:
A. Bone marrow
B. Spleen
C. Lymph nodes
D. Liver
75. Which one of the following organs is responsible for the
maturation of T lymphocytes and regulation of their
expression of CD4 and CD8?
A. Spleen
83. When a patient has severe anemia and the bone marrow is
unable to effectively produce red blood cells to meet the
increased demand, one of the body’s responses is:
A. Extramedullary hematopoiesis in the liver and spleen
B. Decreased production of erythropoietin by the kidney
C. Increased apoptosis of erythrocyte progenitor cells
D. Increased proportion of yellow marrow in the long
bones
84. Hematopoietic stem cells produce all lineages of blood cells
in sufficient quantities over the lifetime of an individual
because they:
A. Are unipotent
B. Have the ability of self-renewal by asymmetric division
C. Are present in large numbers in the bone marrow
niches
D. Have a low mitotic potential in response to growth
factors
85. Which RBC process does not require energy?
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A.
B.
C.
D.
Cytoskeletal protein deformability
Maintaining cytoplasm cationic electrochemical
gradients
Oxygen transport
Preventing the peroxidation of proteins and lipids
86. What pathway anaerobically generates energy in the form of
ATP?
A. 2,3-BPG pathway
B. Embden-Meyerhof Pathway
C. Hexose monophosphate pathway
D. Repoport-Leubering Pathway
87. Which is true concerning 2,3-BPG?
A. Enhances O2 release from hemoglobin
B. Source of RBC ATP
C. Source of RBC glucose
D. The least abundant of RBC organophosphates
88. What hexose-monophosphate shunt products participate in
the detoxification of peroxides?
A. 2,3-BPG and pyruvic acid
B. ATP and lactic acid
C. NADPH and reduced glutathione
D. Pyruvic and lactic acid
89. Which of the following helps maintain RBC shape?
A. Cytoskeletal proteins
B. Glycocalyx
C. GPI anchor
D. Membrane phospholipids
90. The glycolipids of the RBC membrane:
A. Attach the cytoskeleton to the lipid layer
B. Carry RBC antigens
C. Constitute ion channels
D. Provide flexibility
91. RBC membranes block passage of most large molecules,
such as proteins, but allow passage of small molecules such
as the cations Na-, K+, and Ca2+. What is the term for this
membrane property?
A. Deformable
B. Flexible
C. Intangible
D. Semipermeable
92. RBC membrane phospholipids are arranged:
A. In a hexagonal lattice
B. In chains beneath a protein cytoskeleton
C. In two layers whose composition is asymmetric
D. So that hydrophobic portions are facing the plasma
93. RBC membrane cholesterol is replenished from the:
A. Cytoplasm
B. EMB pathway
C. Mitochondria
D. Plasma
94. Hemoglobin iron may become oxidized to Fe3+ by several
pathologic mechanisms. What portion of the EmbdenMyerhof pathway reduces iron to Fe2+?
A. Hexose monophosphate iron to Fe2+
B. Methemoglobin reductase pathway
C. Rapoport-Leubering pathway
D. 2,3-BPG shunt
95. Which o the following is an example of a transmembrane or
integral membrane protein?
A. Actin
B. Ankyrin
C.
D.
Glycophorin A
Spectrin
96. Abnormalities in the horizontal and vertical linkages of the
transmembrane and cytoskeletal RBC membrane proteins
may be seen as:
A. Enzyme pathway deficiencies
B. Methemoglobin increase
C. Reduced hemoglobin content
D. Shape changes
97. Neutrophils and monocytes are direct descendants of a
common progenitor known as:
A. CLP
B. GMP
C. MEP
D. HSC
98. The stage in neutrophilic development in which the nucleus
is indented in a kidney bean shape and the cytoplasm has
secondary granules that are lavender in color is the:
A. Band
B. Myelocyte
C. Promyelocyte
D. Metamyelocyte
99. Type II myeloblasts are characterized by:
A. The presence of fewer than 20 primary granules per
cell
B. Basophilic cytoplasm with many secondary granules
C. The absence of granules
D. The presence of a folded nucleus
100. Which one of the following is a function of neutrophils?
A. Presentation of antigen to T and B lymphocytes
B. Protection against re-exposure by same antigen
C. Nonspecific destruction of foreign organisms
D. Initiation of delayed hypersensitivity response
101. Which of the following cells are important in immune
regulation, allergic inflammation, and destruction of tissue
invading helminths?
A. Neutrophils and monocytes
B. Eosinophils and basophils
C. T and B lymphocytes
D. Macrophages and dendritic cells
102. Basophils and mast cells have high-affinity surface receptors
for which immunoglobulin?
A. A
B. D
C. E
D. G
103. Which of the following cell types is capable of differentiating
into osteoclasts, macrophages or dendritic cells?
A. Neutrophils
B. Lymphocytes
C. Monocytes
D. Eosinophils
104. Macrophages aid in adaptive immunity by:
A. Degrading antigen and presenting it to lymphocytes
B. Ingesting and digesting organisms that neutrophils
cannot
C. Synthesizing complement components
D. Storing iron from senescent red cells
105. Which of the following is the final stage of B cell maturation
after activation by antigen?
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A.
B.
C.
D.
D.
Large, granular lymphocyte
Plasma cell
Reactive lymphocyte
Immunoblast
106. The following is unique to both B and T lymphocytes and
occurs during their early development:
A. Expression of surface antigens CD4 and CD8
B. Maturation in the thymus
C. Synthesis of immunoglobulins
D. Rearrangement of antigen receptor genes
107. Which of the following is an erythroid progenitor?
A. Pronormoblast
B. Reticulocyte
C. CFU-E
D. Orthochromic normoblast
Maturing normoblast slowly lose receptors for adhesive
molecules that bind them to stromal cells
115. What single feature of normal RBCs is most responsible for
limiting their life span?
A. Loss of the nucleus
B. Increased flexibility of the cell membrane
C. Reduction of hemoglobin iron
D. Loss of mitochondria
116. Extravascular hemolysis occurs when:
A. RBCs are mechanically ruptured
B. RBCs extravasate from blood vessels into the tissues
C. Splenic macrophages ingest senescent RBCs
D. RBCs are trapped in blood clots outside the blood
vessels
108. Which of the following is the most mature normoblast?
A. Orthochromic normoblast
B. Basophilic normoblast
C. Pronormoblast
D. Polychromatic normoblast
109. What erythroid precursor can be described as follows: The
cell is of medium size compared with other normoblasts, with
an N:C ratio of nearly 1:1. The nuclear chromatin is
condensed and chunky throughout the nucleus. No nucleoli
are seen. The cytoplasm is gray-blue
A. Reticulocyte
B. Pronormoblast
C. Orthochromic normoblast
D. Polychromatic normoblast
110. At which normoblastic stage does globin production begin?
A. Orthochromic normoblast
B. Pronormoblast
C. Polychromatic normoblast
D. Basophilic normoblast
111. Hypoxia stimulates RBC production by:
A. Inducing more pluripotent stem cells into the erythroid
lineage
B. Stimulating EPO production by the kidney
C. Increasing the number of RBC mitoses
D. Stimulating the production of fibronectin by
macrophages
112. Erythropoietin can increase the production of RBCs by:
A. Promoting apoptosis of erythroid progenitors
B. Decreasing intravascular hemolysis
C. Increasing EPO receptor sites
D. Promoting early release of reticulocytes from bone
marrow
113. In the bone marrow, erythroid precursors are located:
A. Surrounding macrophages in erythroid islands
B. Adjacent to megakaryocytes along the adventitial cell
living
C. Surrounding fat cells in apoptotic islands
D. In the center of the hematopoietic cords
114. Which of the following determines the timing of egress of
RBCs from the bone marrow?
A. Stromal cells decrease production of adhesive
molecules over time as RBCs mature
B. Endothelial cells of the venous sinus form pores at
specified intervals of time, allowing egress of free cells
C. Periodic apoptosis of pronormoblasts in the marrow
cords occurs
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ANSWERS:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
46.
47.
48.
49.
50.
51.
52.
53.
54.
55.
56.
57.
58.
59.
60.
61.
62.
63.
64.
65.
66.
67.
68.
69.
C
C
D
B
B
B
A
A
B
B
D
A
A
D
D
C
A
C
D
C
C
C
D
C
D
B
A
C
B
D
D
B
D
B
B
B
B
D
D
B
C
C
A
B
C
A
D
B
C
D
D
C
D
D
D
B
B
B
D
A
A
D
D
D
D
D
A
C
B
70.
71.
72.
73.
74.
75.
76.
77.
78.
79.
80.
81.
82.
83.
84.
85.
86.
87.
88.
89.
90.
91.
92.
93.
94.
95.
96.
97.
98.
99.
100.
101.
102.
103.
104.
105.
106.
107.
108.
109.
110.
111.
112.
113.
114.
115.
116.
C
B
A
A
D
C
A
B
C
C
B
A
D
A
B
C
B
A
C
A
B
D
C
D
B
C
D
B
D
A
C
B
C
C
A
B
D
C
A
D
B
B
D
A
D
A
C
References:
Rodak’s Hematology Clinical Principles and Applications
(6th Edition)
Clinical Hematology Theory and Procedures by Turgeon
(5th Edition)
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