100+ Free ABIM Hematology Practice Questions

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Question 1

Score: 0/0

A 32-year-old woman with heavy menstrual bleeding presents with fatigue. CBC shows Hgb 9.2 g/dL, MCV 72 fL. Iron studies: ferritin 8 ng/mL, TSAT 10%, TIBC elevated. Which is the most likely diagnosis?

Iron deficiency anemia

Anemia of chronic disease

Beta-thalassemia trait

Sideroblastic anemia

to track

2026 Statistics

Key Facts: ABIM Hematology Exam

~$2,990

ABIM Hematology Fee

ABIM 2026

~220 MCQs

Exam Length

4 modules, ~10 hr day

2-year

Hematology Fellowship

ACGME-accredited

88-95%

First-Time Pass Rate

ABIM historical

ELN 2022

AML Risk Model

Döhner et al.

Dec 2023

FDA CRISPR Exa-cel (SCD)

Casgevy approval

ABIM Hematology is a subspecialty boards covering the full spectrum of benign and malignant blood disorders. High-yield 2022-2024 updates: ELN 2022 AML risk (TP53 adverse), venetoclax-azacitidine for unfit AML per VIALE-A, CAR-T (axi-cel, liso-cel, brex-cel, ide-cel, cilta-cel) and bispecifics (teclistamab, mosunetuzumab, epcoritamab), FDA 2023 gene therapies for SCD (exa-cel/Casgevy CRISPR and lovo-cel/Lyfgenia) and 2022 for β-thalassemia (beti-cel) and hemophilia B (Hemgenix), POLARIX pola-R-CHP replacing R-CHOP for intermediate-high DLBCL, pacritinib (2022) and momelotinib (2023) for thrombocytopenic/anemic myelofibrosis, caplacizumab for iTTP, andexanet alfa for Xa-DOAC reversal, and Dara-VRd quadruplet frontline MM from GRIFFIN/PERSEUS. Typical US hematologist/oncologist compensation is $400K-$600K, with academic and transplant hematologists earning at the high end.

Sample ABIM Hematology Practice Questions

Try these sample questions to test your ABIM Hematology exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 32-year-old woman with heavy menstrual bleeding presents with fatigue. CBC shows Hgb 9.2 g/dL, MCV 72 fL. Iron studies: ferritin 8 ng/mL, TSAT 10%, TIBC elevated. Which is the most likely diagnosis?

A.Iron deficiency anemia

B.Anemia of chronic disease

C.Beta-thalassemia trait

D.Sideroblastic anemia

Explanation: Classic iron deficiency anemia: microcytic (MCV <80), low ferritin (<30 ng/mL is diagnostic; <15 essentially confirms IDA), low TSAT (<20%), and elevated TIBC reflecting upregulated transferrin. ACD shows low/normal TIBC and normal-to-high ferritin. Thalassemia trait has normal iron studies and often target cells. Sideroblastic anemia shows high ferritin and ring sideroblasts on marrow.

2A 68-year-old with rheumatoid arthritis has Hgb 10.5 g/dL, MCV 84 fL, ferritin 220 ng/mL, TSAT 12%, TIBC low. Which mechanism best explains this anemia?

A.Hepcidin-mediated functional iron sequestration

B.Intrinsic factor antibodies blocking B12 absorption

C.Ineffective erythropoiesis with ring sideroblasts

D.Autoimmune destruction of RBCs by warm IgG

Explanation: Anemia of chronic disease (anemia of inflammation) is driven by IL-6-induced hepcidin, which degrades ferroportin, blocking iron export from macrophages and enterocytes. Iron becomes functionally unavailable despite adequate stores — hence high ferritin, low TSAT, low TIBC. This distinguishes ACD from IDA (high TIBC, low ferritin). Mixed IDA+ACD can have ferritin up to ~100 with low TSAT.

3A 24-year-old of Southeast Asian ancestry has MCV 68 fL, Hgb 11.0 g/dL, normal iron studies, and hemoglobin electrophoresis with HbA 97%, HbA2 2.4%, HbF 0.5%. Which finding would support alpha-thalassemia trait?

A.Normal HbA2 and normal HbF with persistent microcytosis

B.Elevated HbA2 >3.5%

C.Elevated HbF 20-30%

D.Presence of HbS on electrophoresis

Explanation: Alpha-thalassemia trait (2-gene deletion) shows microcytosis with normal iron studies and a NORMAL hemoglobin electrophoresis (normal HbA2 and HbF). Diagnosis requires DNA analysis for alpha-globin gene deletion. Beta-thalassemia trait classically shows HbA2 >3.5%. Elevated HbF is seen in HPFH or beta-thalassemia major. HbS indicates sickle cell.

4A Mediterranean male has MCV 65 fL, Hgb 10.8 g/dL, normal iron studies, and HbA2 of 5.2%. Which is the most likely diagnosis?

A.Beta-thalassemia trait

B.Alpha-thalassemia trait

C.Iron deficiency anemia

D.Sickle cell trait

Explanation: Beta-thalassemia trait (minor) is characterized by microcytosis with normal iron studies and elevated HbA2 >3.5% (often 4-6%) due to compensatory delta-globin production when beta-globin is reduced. HbF may be mildly elevated. Alpha-thalassemia shows normal electrophoresis. IDA has low ferritin. Sickle trait shows HbS on electrophoresis.

5A 55-year-old alcoholic has macrocytic anemia (MCV 108 fL), hypersegmented neutrophils, and elevated MMA and homocysteine. Which vitamin deficiency is most likely?

A.Vitamin B12 deficiency

B.Folate deficiency

C.Thiamine deficiency

D.Iron deficiency

Explanation: B12 deficiency causes megaloblastic anemia with elevated BOTH methylmalonic acid (MMA) and homocysteine. Folate deficiency elevates homocysteine only (MMA normal). MMA specificity is the key board distinguishing feature. In alcoholics folate deficiency is common but normal MMA rules B12 out. Treating folate without addressing B12 can precipitate subacute combined degeneration of spinal cord.

6A 70-year-old with macrocytic anemia (MCV 110 fL), neutropenia (ANC 1.1), and thrombocytopenia (plt 85) has hypercellular marrow with dysplasia in all three lineages and 4% blasts. Karyotype shows isolated del(5q). Which therapy is FDA-approved specifically for this cytogenetic finding?

A.Lenalidomide

B.Azacitidine alone

C.Luspatercept

D.Allogeneic HSCT

Explanation: Lenalidomide is specifically indicated for lower-risk MDS with isolated del(5q) deletion, producing transfusion independence in ~65% and cytogenetic responses in ~50%. Azacitidine is standard for higher-risk MDS. Luspatercept treats MDS with ring sideroblasts (MDS-RS) or those failing ESA. Allo-HSCT is for higher-risk fit patients.

7A 28-year-old African American man with known hereditary spherocytosis presents with splenomegaly, jaundice (indirect bili 4.2), reticulocytosis, and Hgb 9 g/dL. Which test is most specific for this diagnosis?

A.EMA binding test (or osmotic fragility)

B.Direct antiglobulin (Coombs) test

C.Hemoglobin electrophoresis

D.G6PD activity

Explanation: Hereditary spherocytosis is diagnosed with the EMA (eosin-5-maleimide) flow cytometry binding test (now preferred over older osmotic fragility) — both exploit decreased membrane spectrin/ankyrin producing reduced surface area. DAT is negative (distinguishes from AIHA which also has spherocytes). Splenectomy cures the hemolysis but is deferred to age 5+ and partial when possible due to infection risk.

8A 45-year-old woman has Hgb 7.8 g/dL, reticulocytes 12%, LDH 850, indirect bili 3.4, haptoglobin <10, and a positive direct antiglobulin test for IgG and C3. Which is the first-line therapy?

A.Prednisone 1 mg/kg/day

B.Splenectomy

C.Rituximab

D.Plasma exchange

Explanation: Warm AIHA (IgG ± C3 on DAT) is first-line treated with glucocorticoids (prednisone 1 mg/kg/day) with ~80% response. Second line: rituximab (preferred) or splenectomy. Third line: azathioprine, MMF, cyclosporine, or the newer FcRn inhibitor. Plasma exchange is not effective. Always check for underlying cause (SLE, CLL, lymphoma, drugs).

9A 22-year-old presents with hemolysis after eating fava beans. Blood smear shows bite cells and Heinz bodies. Which enzyme deficiency is most likely?

A.Glucose-6-phosphate dehydrogenase (G6PD)

B.Pyruvate kinase

C.Hexokinase

D.Adenosine deaminase

Explanation: G6PD deficiency is the most common enzymopathy and is X-linked, producing oxidant-induced hemolysis after exposure to fava beans, sulfa drugs, nitrofurantoin, primaquine/dapsone, or infections. Heinz bodies (denatured Hgb) are removed by splenic macrophages producing 'bite cells.' G6PD level should be measured when NOT actively hemolyzing (reticulocytes have higher enzyme activity, yielding false-normals).

10A 19-year-old with HbSS sickle cell disease has had 4 vaso-occlusive crises this year. Which therapy is most likely to reduce the frequency of painful episodes?

A.Hydroxyurea

B.Warfarin

C.Iron supplementation

D.Folate alone

Explanation: Hydroxyurea is the foundation of SCD therapy — increases HbF, reduces VOC, acute chest syndrome, transfusions, and mortality. Target dose escalation to maximum tolerated. Additional modern agents: L-glutamine (Endari), crizanlizumab (P-selectin inhibitor; voluntarily withdrawn from EU in 2023 for post-approval STAND trial issues but still FDA-approved), voxelotor (HbS polymerization inhibitor; voluntarily withdrawn from market in 2024), and curative therapy with allogeneic HSCT or gene therapy (lovo-cel/Lyfgenia and exa-cel/Casgevy, both FDA-approved December 2023).

About the ABIM Hematology Exam

The ABIM Hematology subspecialty exam certifies internists who have completed a 2-year ACGME-accredited Hematology fellowship (or a 3-year combined Hematology and Medical Oncology fellowship). Content spans anemias (IDA, thalassemia, B12/folate, hemolytic, sickle cell including 2023 FDA gene therapies), hemostasis and thrombosis (vWD, hemophilia, DIC, ITP, TTP, HIT, APS), anticoagulation (DOACs, reversal), acute and chronic leukemias (AML ELN 2022, APL, ALL, CML, CLL), lymphomas (Hodgkin, DLBCL POLARIX, MCL, FL, WM), plasma cell disorders (MM CAR-T, bispecifics, AL amyloidosis), MDS/MPN (pacritinib, momelotinib, avapritinib), transfusion medicine, and HSCT/CAR-T.

Questions

220 scored questions

Time Limit

~10-hour exam day (four ~2-hour modules)

Passing Score

Criterion-referenced scaled score (pass/fail)

Exam Fee

~$2,990 application + exam fee (American Board of Internal Medicine (ABIM))

ABIM Hematology Exam Content Outline

20%

Anemias and Red Cell Disorders

IDA (ferritin <30 ng/mL, TSAT <20%, elevated TIBC), ACD (IL-6/hepcidin, low TSAT with high ferritin), thalassemias (alpha trait normal HbA2; beta trait HbA2 >3.5%), macrocytic (B12 deficiency — MMA and HCY elevated; folate — HCY only; MDS; hypothyroid), hemolytic (spherocytes + splenomegaly extravascular; schistocytes + low haptoglobin intravascular), AIHA (warm IgG Coombs, cold agglutinin IgM → sutimlimab), G6PD (Heinz/bite cells), hereditary spherocytosis (EMA binding), sickle cell disease (hydroxyurea, crizanlizumab, L-glutamine, FDA 2023 exa-cel/lovo-cel gene therapy), PNH (eculizumab/ravulizumab/pegcetacoplan).

18%

Hemostasis and Thrombosis

vWD types (RCo/Ag ratio), DDAVP vs Humate-P; Hemophilia A (FVIII, emicizumab/Hemlibra prophylaxis) and B (FIX, Hemgenix/etranacogene dezaparvovec 2022 gene therapy); DIC (consumptive); ITP (steroids, IVIG, TPO-RAs eltrombopag/romiplostim/avatrombopag, rituximab, fostamatinib); iTTP (ADAMTS13 <10% → PEX + caplacizumab + steroids + rituximab); HIT (4Ts ≥4 → argatroban/bivalirudin/fondaparinux); APS (triple-positive → warfarin not DOAC); inherited thrombophilia (AT highest risk).

10%

Anticoagulation and VTE

Warfarin INR 2-3, reversal with 4F-PCC + IV vit K 10 mg for major bleeding; DOACs apixaban/rivaroxaban/edoxaban (Xa) reversed by andexanet alfa; dabigatran (IIa) by idarucizumab; LMWH (enoxaparin); UFH + protamine. VTE duration: provoked 3 months, unprovoked low-bleed extended indefinite; cancer-associated first-line DOACs per CARAVAGGIO/Hokusai-VTE Cancer except luminal GI; pregnancy — LMWH.

15%

Acute and Chronic Leukemias

AML (ELN 2022: TP53/complex adverse; NPM1 without FLT3 favorable; FLT3 midostaurin/gilteritinib/quizartinib 2023; IDH1 ivosidenib/olutasidenib, IDH2 enasidenib; unfit venetoclax+azacitidine per VIALE-A); APL (t(15;17) → ATRA+ATO, differentiation syndrome → dex, DIC support); ALL (Ph+ TKI + chemo or D-ALBA, blinatumomab, inotuzumab, CAR-T tisa-cel/brex-cel); CML (BCR-ABL IS, TKI milestones, ponatinib/asciminib for T315I); CLL (BTKi acala/zanu preferred, venetoclax-obinutuzumab CLL14, 17p/TP53).

12%

Lymphomas

Classical Hodgkin (ABVD/A-AVD/nivo+AVD per SWOG S1826, nivolumab/pembrolizumab R/R, brentuximab); DLBCL (POLARIX pola-R-CHP intermediate-high, R-CHOP lower-risk, DA-EPOCH-R for double-hit, CAR-T 2L per ZUMA-7/TRANSFORM); MCL (t(11;14), cyclin D1, BTKi, TRIANGLE ibrutinib frontline, brex-cel R/R); FL (watch-and-wait, BR, obinutuzumab, mosunetuzumab/epcoritamab bispecifics); MZL (MALT + H. pylori); Burkitt (t(8;14) MYC, DA-EPOCH-R); WM (MYD88, BTKi, ASPEN zanubrutinib); PCNSL (HD-MTX).

12%

Plasma Cell Disorders

MGUS (Mayo 3-factor risk, ~1%/yr progression), SMM (M ≥3 or PCs 10-60%, 20/2/20 high-risk → consider lenalidomide), active MM (CRAB + SLiM, Dara-VRd quadruplet per GRIFFIN/PERSEUS + auto-HSCT + lenalidomide maintenance), R/R MM (CAR-T ide-cel/cilta-cel, bispecifics teclistamab anti-BCMA/talquetamab anti-GPRC5D), AL amyloidosis (Congo red, apple-green birefringence, Dara-CyBorD per ANDROMEDA, CAEL-101), Waldenström (IgM, MYD88 L265P, BTKi).

MDS and Myeloproliferative Neoplasms

MDS (IPSS-R 5 categories, azacitidine/decitabine for HR, lenalidomide for isolated del(5q), luspatercept for MDS-RS/COMMANDS frontline, ivosidenib IDH1 2023); PV (JAK2 V617F, phlebotomy to Hct <45, aspirin, ropeginterferon alfa-2b/Besremi 2021 approval); ET (JAK2/CALR/MPL, IPSET-thrombosis, hydroxyurea first-line); MF (DIPSS-plus/MIPSS70+, ruxolitinib COMFORT, fedratinib JAKARTA, pacritinib 2022 plt <50k, momelotinib 2023 anemia); HLH (HLH-2004 criteria); mastocytosis (KIT D816V, avapritinib PIONEER 2023).

Transfusion Medicine and HSCT

RBC threshold Hgb <7 (TRICC, MINT, Villanueva), platelets <10k stable or <50k for procedures, cryo fibrinogen <100-150, TRALI (anti-HLA/HNA) vs TACO (BNP high) vs allergic/FNHTR, irradiation to prevent TA-GVHD, CMV-seronegative/leukoreduced for immunocompromised. HSCT: MAC vs RIC, PTCy haplo-HSCT; GVHD acute (steroids 1st, ruxolitinib REACH-2) and chronic (ruxolitinib REACH-3, ibrutinib, belumosudil, ECP); SOS/VOD (defibrotide); CAR-T CRS (tocilizumab + steroids) and ICANS (steroids).

How to Pass the ABIM Hematology Exam

What You Need to Know

Passing score: Criterion-referenced scaled score (pass/fail)
Exam length: 220 questions
Time limit: ~10-hour exam day (four ~2-hour modules)
Exam fee: ~$2,990 application + exam fee

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

ABIM Hematology Study Tips from Top Performers

1Memorize the ELN 2022 AML risk framework: Favorable (t(8;21), inv(16), NPM1 without FLT3-ITD), Adverse (TP53, complex karyotype, -5/-7, inv(3), KMT2A with adverse partners, multiple myelodysplasia-related mutations), Intermediate (NPM1 with FLT3-ITD, others). Know which mutation pairs with which targeted therapy — FLT3 (midostaurin, gilteritinib, quizartinib 2023), IDH1 (ivosidenib, olutasidenib), IDH2 (enasidenib), and venetoclax-azacitidine for unfit patients from VIALE-A.

2For hemostasis emergencies, use the classic labs gestalt: DIC (prolonged PT/aPTT + low platelets + low fibrinogen + high D-dimer); TTP (MAHA + thrombocytopenia + fever + renal + neuro, ADAMTS13 <10% → PEX + caplacizumab + steroids); HIT (4Ts ≥4, platelets drop 30-50% day 5-10 → stop heparin, argatroban/bivalirudin/fondaparinux, never warfarin monotherapy). For reversal: 4F-PCC + vit K (warfarin), andexanet (Xa DOAC), idarucizumab (dabigatran), protamine (heparin).

3Lock in the 2022-2024 FDA approvals and pivotal trials: Casgevy (exa-cel CRISPR) and Lyfgenia (lovo-cel) for SCD Dec 2023; Hemgenix (etranacogene) for hemophilia B 2022 and Beqvez 2024; POLARIX (pola-R-CHP) for DLBCL; GRIFFIN/PERSEUS (Dara-VRd quadruplet) for MM; VIALE-A (ven-aza) for unfit AML; ZUMA-7/TRANSFORM (CAR-T 2L DLBCL); CARTITUDE-4 and KarMMa-3 (CAR-T earlier in MM); pacritinib 2022 MF plt <50k; momelotinib 2023 MF with anemia; avapritinib 2021 AdvSM and PIONEER 2023 ISM.

4Learn the classic 'board buzzword triggers': Auer rods → AML (or APL with faggot cells); Philadelphia chromosome t(9;22) → CML or Ph+ ALL (add TKI); t(15;17) → APL + ATRA/ATO urgently; Reed-Sternberg + CD30+ CD15+ → classical Hodgkin; t(11;14)/cyclin D1 → mantle cell; t(8;14) MYC → Burkitt; t(14;18) BCL2 → follicular; MYD88 L265P → Waldenström; JAK2 V617F → PV/ET/MF; KIT D816V → systemic mastocytosis; Congo red apple-green birefringence → amyloid; smudge cells → CLL; tear-drop cells + dry tap → myelofibrosis.

5Master the 2022-2024 anticoagulation updates: cancer-associated VTE now first-line DOAC (apixaban/rivaroxaban/edoxaban) per CARAVAGGIO and Hokusai-VTE Cancer — except luminal GI (edoxaban bleeding signal) and unresected GU cancers. Provoked VTE = 3 months; unprovoked low-bleed = extended indefinite (apixaban 2.5 mg BID or rivaroxaban 10 mg daily per AMPLIFY-EXT/EINSTEIN-CHOICE). Pregnancy always LMWH (no warfarin teratogenic, no DOAC). Triple-positive APS uses warfarin (DOACs failed in TRAPS).

Frequently Asked Questions

Who is eligible to sit for the ABIM Hematology subspecialty exam?

Candidates must hold current ABIM Internal Medicine certification and must have completed a 2-year ACGME-accredited Hematology fellowship, or a 3-year combined Hematology and Medical Oncology fellowship. A valid, unrestricted US medical license and verification of clinical competence by the program director are also required.

How is the ABIM Hematology exam structured?

The Hematology exam is a single-day, computer-based test at Pearson VUE containing approximately 220 single-best-answer MCQs delivered in four modules of roughly two hours each, with an overall ~10-hour exam day including tutorials and breaks. Content is distributed across the ABIM Hematology blueprint, emphasizing anemias, hemostasis/thrombosis, malignant hematology, plasma cell disorders, MPN/MDS, transfusion medicine, and HSCT/cellular therapy.

How much does the ABIM Hematology exam cost?

The ABIM application plus exam fee for Hematology is approximately $2,990 in 2026. Late fees apply after the regular deadline. Always check the current ABIM fee schedule, as fees change annually. Budget additional funds for review courses ($500-$2,000), textbooks, and question banks.

What is the pass rate for the ABIM Hematology boards?

ABIM-reported first-time pass rates for Hematology have historically been in the 88-95% range, reflecting a fellowship-trained candidate pool. Pass rates for repeat takers are substantially lower. Check ABIM's annual pass-rate report for current data.

What topics are highest yield on the Hematology boards?

AML risk stratification (ELN 2022, TP53/complex karyotype adverse), venetoclax-azacitidine for unfit AML (VIALE-A), APL (ATRA+ATO, differentiation syndrome), CML (TKI milestones, T315I → ponatinib/asciminib), CLL (BTKi, venetoclax, 17p/TP53), DLBCL (POLARIX pola-R-CHP), MM (Dara-VRd per GRIFFIN/PERSEUS, CAR-T, bispecifics), iTTP (caplacizumab), HIT (4Ts), DOAC reversal (andexanet/idarucizumab), and 2023 FDA gene therapies for sickle cell (exa-cel, lovo-cel).

What references are recommended for ABIM Hematology prep?

The ASH Self-Assessment Program (ASH-SAP) is essential — considered by many the single highest-yield resource. Also high-yield: Williams Hematology, Hoffman's Hematology: Basic Principles and Practice, UpToDate hematology section, ASH and NCCN guidelines (lymphoma, myeloma, leukemia, MPN), ELN 2022 AML recommendations, and board review question banks with detailed rationales (ASH Board Review, MKSAP Hematology sections, Knowmedge).

How do I maintain my Hematology certification after passing?

ABIM offers continuous MOC via the Longitudinal Knowledge Assessment (LKA) — roughly 30 questions per quarter, open-book, with feedback — or a traditional 10-year recertification exam. You must keep your underlying Internal Medicine certification active and meet ABIM professional standing requirements (valid license, complete assessments on time).

Is ABIM Hematology certification worth it career-wise?

Yes for practicing hematologists, particularly in academic medicine, HSCT/CAR-T programs, and hematology-focused community practices. Most major cancer centers and HSCT programs require board certification. Most hematologists pursue combined Hematology/Oncology boards via a 3-year fellowship and dually certify. US compensation typically ranges $400K-$600K+, higher in academic transplant and structural roles.