Hematology Practice Questions

Q: Maximum life of transfused RBCs is

80-100 days. ***80-100 days*** - The maximum lifespan of **transfused red blood cells (RBCs)** is reduced compared to naturally occurring RBCs in vivo. - This is due to storage conditions and the age of the donated blood, leading to a shorter survival time post-transfusion. *110-120 days* - This range typically represents the **normal lifespan of red blood cells in the human body** *in vivo*, not the effective lifespan of transfused units. - Transfused RBCs undergo various changes during storage (storage lesion) that reduce their post-transfusion survival. *60-80 days* - While closer to the actual range for transfused RBCs, this is generally considered a slightly **underestimated maximum lifespan**. - The survival of transfused RBCs can vary, but good quality units usually last longer than 80 days. *50-60 days* - This range is typically too low for the maximum lifespan of transfused RBCs, indicating either **poor quality blood products** or significantly **prolonged storage times**. - Most transfused RBCs, when properly stored and handled, will survive for a longer duration post-transfusion.

Q: Hypercoagulability due to a defective factor V gene is known as which of the following?

Leiden mutation. ***Leiden mutation*** - The **factor V Leiden mutation** leads to a hypercoagulable state by causing resistance to activated protein C, increasing the risk of venous thrombosis [1]. - It is the most common inherited cause of venous thromboembolism and directly associates with the defective factor V gene [1]. *Antiphospholipid syndrome* - This syndrome is characterized by the presence of **antiphospholipid antibodies** leading to recurrent thrombosis but is not directly related to the factor V gene. - It often presents with symptoms such as **venous and arterial thrombosis**, but its mechanism differs from that of factor V Leiden [2]. *Inducible thrombocytopenia syndrome* - This condition involves **thrombocytopenia** (low platelet count) often due to medication, which is unrelated to the hypercoagulable state from factor V mutation. - It does not involve the **factor V gene** nor lead to an increased risk of clotting as seen in the Leiden mutation. *Lisbon mutation* - The Lisbon mutation is a rare variant of factor V but is not the primary mutation associated with the hypercoagulable state in most cases. - It does not have the same wide clinical implications or prevalence as the **factor V Leiden mutation**.

Q: Which of the following is NOT a feature of G-6PD deficiency?

Hereditary spherocytosis. ***Membrane defect*** - **G-6PD deficiency** is primarily characterized by a deficiency in the enzyme glucose-6-phosphate dehydrogenase, rather than a membrane defect [1]. - It leads to **oxidative stress** rather than issues with red blood cell membranes [1]. *Bite cells* - Bite cells are actually a result of **oxidative damage** due to G-6PD deficiency and occur during hemolytic episodes [2]. - They are formed when **macrophages** remove denatured hemoglobin from erythrocytes. *Intravascular hemolysis* - This condition often occurs in G-6PD deficiency due to oxidative stress leading to the destruction of red blood cells, particularly during crises [2]. - The hemolysis is often **acute** and triggered by infections, certain drugs, or food (like fava beans) [3]. *Oxidative stress* - Oxidative stress is a key pathological mechanism in G-6PD deficiency, causing vulnerability of red blood cells to hemolysis [1]. - It leads to **increased susceptibility** to infections and hemolytic episodes upon exposure to oxidant drugs or agent [2].

Q: Autoimmune gastritis is associated with a deficiency of which vitamin?

Vitamin B12. ***B12*** - Autoimmune gastritis leads to destruction of **parietal cells** in the stomach, impairing intrinsic factor production, crucial for vitamin B12 absorption [2]. - Vitamin B12 deficiency can lead to **megaloblastic anemia** and neurological complications due to its key role in DNA synthesis and nerve function [1]. *C* - Vitamin C deficiency is associated with **scurvy**, which is unrelated to autoimmune gastritis and is not a consequence of gastric issues. - This vitamin primarily concerns skin health, collagen synthesis, and immune function, making it irrelevant in this context. *A* - Vitamin A deficiency is associated with **vision problems** and immune function, but it does not have a direct link to autoimmune gastritis. - Unlike B12, vitamin A is not specifically affected by the gastric conditions related to autoimmune processes. *D* - Vitamin D deficiency relates to **bone health** and calcium metabolism, and is not connected to the effects of autoimmune gastritis. - This vitamin's absorption primarily occurs in the intestines rather than involving gastric intrinsic factor or parietal cells.

Q: Gall stones in hemolytic anaemia are -

Pigment. ***Pigment*** - In hemolytic anemia, the breakdown of hemoglobin increases bilirubin levels, leading to the formation of **pigment stones (bilirubin stones)** [1]. - These stones are typically small, dark, and made up of **calcium bilirubinate** due to excessive unconjugated bilirubin. *Any type* - This option is incorrect as it suggests that all types of gallstones can occur, which is not true for hemolytic anemia. - While cholesterol stones are common in general, they are not specifically associated with **hemolysis**. *Cholesterol* - Cholesterol stones are primarily associated with **bile saturation** and are not a result of hemolytic conditions. - They arise from an imbalance in bile salts and cholesterol rather than from **bilirubin metabolism**. *Mixed* - Mixed stones contain cholesterol and pigment, but they are less represented in hemolytic conditions compared to **pure pigment stones**. - Hemolytic anemia primarily leads to the formation of **pigment stones** [1], not a predominance of mixed stones.

Q: Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?

Microangiopathic hemolytic anemia. ### a and c - Hemolytic Uremic Syndrome (HUS) is characterized by **microangiopathic hemolytic anemia** along with **thrombocytopenia**, making this correct [1][2]. - It typically results from an **infection**, often associated with **E. coli**, particularly in children [2]. *Positive Coomb's test* - A positive Coomb's test suggests **autoimmune hemolytic anemia**, not HUS. - HUS generally presents with **negative Coomb's test**, indicating hemolysis mechanism is different from autoimmune causes. *Microangiopathic haemolytic anaemia* - While HUS does involve **microangiopathic hemolytic anemia** [2], this alone does not encompass all its characteristics necessary for diagnosis. - HUS must also include **thrombocytopenia**, which is not mentioned in this option [1]. *Thrombocytopenia* - Thrombocytopenia is indeed a feature of HUS, but presenting it alone lacks the context of the complete syndrome [1]. - HUS must also show **microangiopathic hemolytic anemia** to align with the complete clinical picture [2], which is missing here.

Q: First line investigation for deep venous thrombosis is -

Ultrasonography. ***Ultrasonography*** - **Duplex ultrasonography** is the preferred first-line investigation due to its **non-invasiveness**, widespread availability, and high accuracy for diagnosing DVT, especially in the proximal veins [1][2]. - It visualizes the vein and assesses compressibility, flow, and presence of thrombus, making it effective for **confirming or excluding DVT** [1][2]. *Venography* - **Venography** is an invasive procedure involving injection of contrast dye and X-rays, carrying risks of allergic reactions and kidney injury. - While considered the **gold standard** for detailed anatomical visualization, its invasiveness and risks make it a second-line or confirmatory test rather than a first-line diagnostic. *MRI* - **Magnetic Resonance Imaging (MRI)** is highly sensitive and specific for DVT, particularly for pelvic or atypical thrombi. - However, its **high cost**, limited availability, and longer acquisition time usually reserve it for cases where ultrasound is inconclusive or technically difficult. *Nuclear imaging* - **Nuclear imaging**, such as scintigraphy, is primarily used for diagnosing **pulmonary embolism (PE)** with Ventilation-Perfusion (V/Q) scans [2]. - It is **not a standard or primary diagnostic tool** for evaluating DVT directly, as it does not visualize thrombi in the venous system.

Q: On medical check-up of a Punjabi student, the following findings were seen: Hb of 9.9 gm/dL, RBC count of 5.1 million, MCV of 62.5 fL, and RDW of 13.51%. What is the most probable diagnosis?

Thalassemia trait. ***Thalassemia trait*** - The low **MCV (62.5 fl)** and normocytic **RBC count (5.1 million)** indicate microcytic anemia, typical of thalassemia trait. - The **RDW of 13.51%** is relatively normal, distinguishing it from iron deficiency anemia where RDW would be elevated. *Anemia of chronic disease* - This condition usually presents with **normocytic or microcytic anemia**, but typically involves a **low serum iron** and **high ferritin**, which are not mentioned here [1]. - It is often associated with chronic inflammatory conditions, not fitting the RBC parameters given [2]. *HbD* - HbD is a hemoglobin variant typically identified in **specific ethnic groups**, but it does not cause significant anemia like described here with low MCV. - Diagnosis is based on specific hemoglobin electrophoresis patterns, which are not indicated in this case. *Iron deficiency anemia* - Would typically show **lower ferritin levels** and higher RDW, indicating a variation in red cell size, which contrasts with the given RDW [1]. - The RBC count is normal, while iron deficiency often presents with *low RBC counts* and microcytic indices [2].

Q: Which of the following is LEAST likely to increase the risk of developing deep vein thrombosis (DVT)?

Age less than 40. ### Age less than 40 - Younger age is considered a **protective factor** against DVT, as the risk generally increases with age due to accumulated comorbidities and decreased mobility. [1] - While DVT can occur at any age, the incidence is significantly lower in individuals under 40 years old, especially in the absence of other strong risk factors. [3] ### Prolonged immobilization - **Immobilization** significantly reduces blood flow velocity in the lower extremities, leading to **venous stasis**. [2] - This stasis promotes the accumulation of clotting factors and activation of the coagulation cascade, increasing the risk of thrombus formation. ### Obesity - Obesity is a significant risk factor for DVT due to its association with **chronic inflammation**, **endothelial dysfunction**, and a **prothrombotic state**. - Increased abdominal pressure from obesity can also impede venous return, further contributing to venous stasis. ### Extensive pelvic surgery of more than 30 minutes - Surgical procedures, particularly those involving the pelvis and lasting longer than 30 minutes, cause **endothelial injury**, activate the **coagulation system**, and result in **postoperative immobility**. [2] - These factors collectively contribute to Virchow's triad (venous stasis, endothelial injury, hypercoagulability), significantly increasing DVT risk.

Q: Which of the following does not cause intravascular hemolysis?

Hereditary spherocytosis. ***Hereditary spherocytosis*** - It primarily causes **extravascular hemolysis** due to spleen sequestration of **abnormal erythrocytes** [2]. - Not typically associated with **intravascular hemolysis**, making it the correct choice here. *Mismatched blood transfusion* - Causes acute **intravascular hemolysis** due to **antibody-mediated destruction** of foreign red blood cells [1]. - Results in **hemoglobinuria**, high bilirubin levels, and potential **renal failure**. *Paroxysmal cold hemoglobinuria* - Induces **intravascular hemolysis** triggered by cold temperatures and **anti-P antibodies** [3]. - Characterized by **acute hemoglobinuria** upon rewarming, complicating the clinical picture [3]. *Thermal burns* - Can lead to **intravascular hemolysis** due to damage to red blood cells from extreme heat. - Associated with **massive tissue injury** and resultant hemolytic reactions in the bloodstream.

Question 1

Maximum life of transfused RBCs is

Accepted Answer

80-100 days

Answer

60-80 days

Answer

50-60 days

Answer

110-120 days

Question 2

Hypercoagulability due to a defective factor V gene is known as which of the following?

Accepted Answer

Leiden mutation

Answer

Antiphospholipid syndrome

Answer

Prothrombin G20210A mutation

Answer

Protein C deficiency

Question 3

Which of the following is NOT a feature of G-6PD deficiency?

Accepted Answer

Hereditary spherocytosis

Answer

Oxidative stress

Answer

Bite cells

Answer

Intravascular hemolysis

Question 4

Autoimmune gastritis is associated with a deficiency of which vitamin?

Accepted Answer

Vitamin B12

Answer

Vitamin C

Answer

Vitamin D

Answer

Vitamin A

Question 5

Gall stones in hemolytic anaemia are -

Accepted Answer

Pigment

Answer

Mixed

Answer

Cholesterol

Answer

Any type

Question 6

Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?

Accepted Answer

Microangiopathic hemolytic anemia

Answer

Thrombocytopenia

Answer

Positive Coomb's test

Answer

All of the options

Question 7

First line investigation for deep venous thrombosis is -

Accepted Answer

Ultrasonography

Answer

Venography

Answer

MRI

Answer

Nuclear imaging

Question 8

On medical check-up of a Punjabi student, the following findings were seen: Hb of 9.9 gm/dL, RBC count of 5.1 million, MCV of 62.5 fL, and RDW of 13.51%. What is the most probable diagnosis?

Accepted Answer

Thalassemia trait

Answer

HbD

Answer

Iron deficiency anemia

Answer

Anemia of chronic disease

Question 9

Which of the following is LEAST likely to increase the risk of developing deep vein thrombosis (DVT)?

Accepted Answer

Age less than 40

Answer

Obesity

Answer

Prolonged immobilization

Answer

Extensive pelvic surgery of more than 30 minutes

Question 10

Which of the following does not cause intravascular hemolysis?

Accepted Answer

Hereditary spherocytosis

Answer

Mismatched blood transfusion

Answer

Paroxysmal cold hemoglobinuria

Answer

Thermal burns

Hematology — MCQs

Hematology — MCQs

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