1|Page
ASCP BOC MLS/MLT PRACTICE EXAM
2026: 100 HIGH-YIELD QUESTIONS
WITH ANSWERS & RATIONALES |
GRADED A+ | FIRST-TRY PASS
GUARANTEE
# Table of Contents
1. **Hematology** – Questions 1–15
2. **Clinical Chemistry** – Questions 16–30
3. **Microbiology** – Questions 31–45
4. **Blood Bank (Immunohematology)** – Questions 46–60
5. **Urinalysis & Body Fluids** – Questions 61–70
6. **Laboratory Operations & Safety** – Questions 71–80
7. **Immunology** – Questions 81–90
8. **Molecular Diagnostics & Special Topics** – Questions 91–100
,2|Page
# Hematology (Questions 1–15)
**Question 1**
A peripheral blood smear shows numerous schistocytes. The patient has
a low haptoglobin and elevated LDH. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Thalassemia minor
C. Thrombotic thrombocytopenic purpura (TTP)
D. Polycythemia vera
**Rationale 1:**
**Correct answer: C** – Schistocytes (RBC fragments) + low
haptoglobin + elevated LDH = microangiopathic hemolytic anemia
(MAHA). TTP/HUS are classic causes. Iron deficiency causes
microcytes, not schistocytes. Thalassemia minor causes target cells, not
schistocytes. Polycythemia vera causes increased RBC mass, not
hemolysis.
---
**Question 2**
What is the expected CBC finding in a patient with **untreated
pernicious anemia**?
A. Microcytic, hypochromic RBCs, low RDW
,3|Page
B. Macrocytic RBCs, hypersegmented neutrophils, low RBC count
C. Normocytic RBCs, thrombocytosis
D. Spherocytes, high reticulocyte count
**Rationale 2:**
**Correct answer: B** – Pernicious anemia (B12 deficiency) causes
megaloblastic anemia → macrocytic RBCs (high MCV),
hypersegmented neutrophils (≥5 lobes), and low RBC count due to
ineffective erythropoiesis.
---
**Question 3**
A Wright-stained smear shows numerous **blasts with Auer rods**.
Which cytochemical stain would be most helpful?
A. Periodic acid-Schiff (PAS)
B. Sudan black B (or MPO)
C. Tartrate-resistant acid phosphatase (TRAP)
D. Non-specific esterase (NSE)
**Rationale 3:**
**Correct answer: B** – Auer rods are pathognomonic for acute
myeloid leukemia (AML). Sudan black B (or myeloperoxidase) is
positive in myeloid blasts. PAS is positive in ALL and erythroleukemia.
, 4|Page
TRAP is positive in hairy cell leukemia. NSE is positive in monocytic
differentiation.
---
**Question 4**
Which condition is associated with **hemoglobin C (HbC) disease**?
A. Target cells and crystals inside RBCs
B. Sickle cells on every field
C. Heinz bodies after splenectomy
D. Basophilic stippling only
**Rationale 4:**
**Correct answer: A** – HbC disease (homozygous) shows target cells
and hexagonal/intracellular HbC crystals on smear. Sickle cells are in
HbS disease. Heinz bodies (oxidized hemoglobin) occur in G6PD
deficiency or unstable hemoglobins.
---
**Question 5**
A patient has PT 25 sec (ref 11–13.5), PTT 80 sec (ref 25–35), platelets
120 x10^9/L. Mixing study corrects both immediately. Next step?
ASCP BOC MLS/MLT PRACTICE EXAM
2026: 100 HIGH-YIELD QUESTIONS
WITH ANSWERS & RATIONALES |
GRADED A+ | FIRST-TRY PASS
GUARANTEE
# Table of Contents
1. **Hematology** – Questions 1–15
2. **Clinical Chemistry** – Questions 16–30
3. **Microbiology** – Questions 31–45
4. **Blood Bank (Immunohematology)** – Questions 46–60
5. **Urinalysis & Body Fluids** – Questions 61–70
6. **Laboratory Operations & Safety** – Questions 71–80
7. **Immunology** – Questions 81–90
8. **Molecular Diagnostics & Special Topics** – Questions 91–100
,2|Page
# Hematology (Questions 1–15)
**Question 1**
A peripheral blood smear shows numerous schistocytes. The patient has
a low haptoglobin and elevated LDH. What is the most likely diagnosis?
A. Iron deficiency anemia
B. Thalassemia minor
C. Thrombotic thrombocytopenic purpura (TTP)
D. Polycythemia vera
**Rationale 1:**
**Correct answer: C** – Schistocytes (RBC fragments) + low
haptoglobin + elevated LDH = microangiopathic hemolytic anemia
(MAHA). TTP/HUS are classic causes. Iron deficiency causes
microcytes, not schistocytes. Thalassemia minor causes target cells, not
schistocytes. Polycythemia vera causes increased RBC mass, not
hemolysis.
---
**Question 2**
What is the expected CBC finding in a patient with **untreated
pernicious anemia**?
A. Microcytic, hypochromic RBCs, low RDW
,3|Page
B. Macrocytic RBCs, hypersegmented neutrophils, low RBC count
C. Normocytic RBCs, thrombocytosis
D. Spherocytes, high reticulocyte count
**Rationale 2:**
**Correct answer: B** – Pernicious anemia (B12 deficiency) causes
megaloblastic anemia → macrocytic RBCs (high MCV),
hypersegmented neutrophils (≥5 lobes), and low RBC count due to
ineffective erythropoiesis.
---
**Question 3**
A Wright-stained smear shows numerous **blasts with Auer rods**.
Which cytochemical stain would be most helpful?
A. Periodic acid-Schiff (PAS)
B. Sudan black B (or MPO)
C. Tartrate-resistant acid phosphatase (TRAP)
D. Non-specific esterase (NSE)
**Rationale 3:**
**Correct answer: B** – Auer rods are pathognomonic for acute
myeloid leukemia (AML). Sudan black B (or myeloperoxidase) is
positive in myeloid blasts. PAS is positive in ALL and erythroleukemia.
, 4|Page
TRAP is positive in hairy cell leukemia. NSE is positive in monocytic
differentiation.
---
**Question 4**
Which condition is associated with **hemoglobin C (HbC) disease**?
A. Target cells and crystals inside RBCs
B. Sickle cells on every field
C. Heinz bodies after splenectomy
D. Basophilic stippling only
**Rationale 4:**
**Correct answer: A** – HbC disease (homozygous) shows target cells
and hexagonal/intracellular HbC crystals on smear. Sickle cells are in
HbS disease. Heinz bodies (oxidized hemoglobin) occur in G6PD
deficiency or unstable hemoglobins.
---
**Question 5**
A patient has PT 25 sec (ref 11–13.5), PTT 80 sec (ref 25–35), platelets
120 x10^9/L. Mixing study corrects both immediately. Next step?
