Hematology — MCQs
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Which of the following is NOT a feature of G-6PD deficiency?
Autoimmune gastritis is associated with a deficiency of which vitamin?
Hypercoagulability due to a defective factor V gene is known as which of the following?
Gall stones in hemolytic anaemia are -
Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?
Maximum life of transfused RBCs is
First line investigation for deep venous thrombosis is -
What is used for exchange blood transfusion?
Which of the following does not cause intravascular hemolysis?
Mentzer index more than 13 suggests a diagnosis of
Hematology Indian Medical PG Practice Questions and MCQs
Question 1041: Which of the following is NOT a feature of G-6PD deficiency?
- A. Oxidative stress
- B. Hereditary spherocytosis (Correct Answer)
- C. Bite cells
- D. Intravascular hemolysis
Explanation: ***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].
Question 1042: Autoimmune gastritis is associated with a deficiency of which vitamin?
- A. Vitamin C
- B. Vitamin D
- C. Vitamin A
- D. Vitamin B12 (Correct Answer)
Explanation: ***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.
Question 1043: Hypercoagulability due to a defective factor V gene is known as which of the following?
- A. Leiden mutation (Correct Answer)
- B. Antiphospholipid syndrome
- C. Prothrombin G20210A mutation
- D. Protein C deficiency
Explanation: ***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**.
Question 1044: Gall stones in hemolytic anaemia are -
- A. Pigment (Correct Answer)
- B. Mixed
- C. Cholesterol
- D. Any type
Explanation: ***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.
Question 1045: Which of the following is the MOST characteristic feature of Hemolytic Uremic Syndrome (HUS)?
- A. Thrombocytopenia
- B. Positive Coomb's test
- C. Microangiopathic hemolytic anemia (Correct Answer)
- D. All of the options
Explanation: ### 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.
Question 1046: Maximum life of transfused RBCs is
- A. 60-80 days
- B. 50-60 days
- C. 110-120 days
- D. 80-100 days (Correct Answer)
Explanation: ***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.
Question 1047: First line investigation for deep venous thrombosis is -
- A. Ultrasonography (Correct Answer)
- B. Venography
- C. MRI
- D. Nuclear imaging
Explanation: ***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.
Question 1048: What is used for exchange blood transfusion?
- A. Whole blood (Correct Answer)
- B. EPP
- C. Serum
- D. Packed cells
Explanation: ***Whole blood*** - Exchange blood transfusion aims to replace a significant volume of the patient's blood with donor blood, making **whole blood** the most appropriate component. - Using whole blood helps to concurrently address **anemia** (due to red blood cells), correct **coagulopathies** (due to plasma and platelets), and remove harmful substances like bilirubin or antibodies. *EPP* - EPP likely refers to **Erythrocyte Progenitor Cells** or another experimental component not routinely used for massive blood replacement. - It does not contain the plasma or platelets necessary for comprehensive exchange transfusion. *Serum* - **Serum** is plasma from which clotting factors have been removed and primarily contains antibodies and other proteins. - It lacks red blood cells and clotting factors, making it unsuitable for an exchange transfusion that requires oxygen-carrying capacity and coagulation support. *Packed cells* - **Packed red blood cells** are primarily used to increase oxygen-carrying capacity and treat anemia. - While they are a component of whole blood, they lack plasma and platelets, which are crucial for maintaining oncotic pressure, replacing clotting factors, and diluting harmful substances during an exchange transfusion.
Question 1049: Which of the following does not cause intravascular hemolysis?
- A. Mismatched blood transfusion
- B. Paroxysmal cold hemoglobinuria
- C. Thermal burns
- D. Hereditary spherocytosis (Correct Answer)
Explanation: ***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 1050: Mentzer index more than 13 suggests a diagnosis of
- A. Iron deficiency anemia (Correct Answer)
- B. Thalassemia
- C. Hereditary Spherocytosis
- D. Autoimmune Hemolytic Anemia
Explanation: ***Iron deficiency anemia*** - A Mentzer index of **greater than 13** (calculated as MCV/RBC count) is highly suggestive of **iron deficiency anemia**. [1] - This index helps differentiate iron deficiency from thalassemia trait in microcytic anemias, as **MCV is disproportionately low** compared to RBC count in IDA. *Thalassemia* - Thalassemia typically presents with a **Mentzer index less than 13**, meaning the MCV reduction is proportional to or less severe than the RBC count reduction. - This condition is characterized by **reduced alpha or beta globin chain synthesis**, leading to microcytic hypochromic red blood cells but often with an elevated RBC count. *Hereditary Spherocytosis* - Hereditary spherocytosis is a **normocytic or macrocytic anemia**, not typically microcytic, making the Mentzer index less relevant for its diagnosis. - It is characterized by **spherocytes** on peripheral smear and increased red cell fragility due to membrane defects. *Autoimmune Hemolytic Anemia* - Autoimmune hemolytic anemia is typically a **normocytic to macrocytic anemia** [2] with features of hemolysis, such as elevated LDH and indirect bilirubin. - While it can be severe, it is not primarily characterized by **microcytosis** and therefore the Mentzer index is not a diagnostic tool for this condition.
Practice by Chapter
Anemia Evaluation and Management
Practice Questions
Hemoglobinopathies
Practice Questions
Thalassemias
Practice Questions
Platelet Disorders
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Coagulation Disorders
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Thrombotic Disorders
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Leukemias
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Lymphomas
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Multiple Myeloma and Plasma Cell Disorders
Practice Questions
Myeloproliferative Neoplasms
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Transfusion Medicine
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Hematopoietic Stem Cell Transplantation
Practice Questions
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