Hematology Practice Questions

Q: In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Packed cells. ***Packed cells*** - **Packed red blood cells (PRBCs)** increase **oxygen-carrying capacity** with minimal volume expansion, which is crucial in patients with cardiac compromise [1]. - Slow infusion of PRBCs, often with a **diuretic**, can improve anaemia and cardiac function while preventing **fluid overload**. *Platelets* - **Platelets** are primarily transfused for **thrombocytopenia** or **platelet dysfunction** to prevent or treat bleeding. - They do not address the low haemoglobin and oxygen-carrying deficit directly contributing to cardiac failure in an anaemic patient. *Whole blood* - **Whole blood** contains plasma, which can significantly increase circulatory volume and worsen **cardiac failure** in patients already struggling with fluid balance. - While it does provide red cells, the added volume makes it a less safe option compared to packed cells in this scenario. *Exchange transfusion* - An **exchange transfusion** involves removing a patient's blood and replacing it with donor blood, typically used for severe conditions like **sickle cell crisis** or **severe hyperbilirubinemia** [2]. - This procedure is complex and carries higher risks, and is not the first-line treatment for anaemia-induced cardiac failure in pregnancy.

Q: Which of the following conditions does not provide protection against malaria?

PNH. ***PNH*** - **Paroxysmal Nocturnal Hemoglobinuria (PNH)** does not provide protection against malaria; it is a disorder of the blood that leads to red blood cell destruction, but malaria specifically targets red blood cells. - PNH is associated with increased risk of venous thrombosis and hemolytic anemia, rather than any protective mechanism against malaria. *Sickle cell anemia* - The sickle cell trait provides a **protective advantage** against malaria by offering some resistance due to the abnormal shape of the cells [1]. - Individuals with the trait have a lower risk of severe malaria, particularly caused by *Plasmodium falciparum* [1]. *Duffy blood group* - People with the **Duffy negative phenotype** are resistant to certain strains of malaria, as the Duffy antigen serves as a receptor for *Plasmodium vivax*. - Therefore, those lacking the Duffy antigen are less susceptible to infections by this malaria strain. *Thalassemia* - Thalassemia provides a protective effect against malaria by producing **abnormal hemoglobin**, which malaria parasites cannot easily thrive in [2]. - This leads to an altered red blood cell environment that is less favorable for *Plasmodium* infection [1].

Q: Which of the following is not a recognized risk factor for deep vein thrombosis (DVT)?

Age less than forty years. The incidence of DVT increases with age, particularly after 40 years [1]. While DVT can occur at any age, it is much **less common in younger individuals** unless other significant risk factors are present [1]. *Duration of surgery more than thirty minutes* - **Prolonged immobility** during surgery, especially for durations longer than 30 minutes, significantly increases the risk of DVT due to venous stasis [2]. - Surgical procedures themselves can cause **endothelial injury** and activate the coagulation cascade, further contributing to thrombus formation [2]. *Obesity* - **Obesity** is a well-established risk factor for DVT, as it is associated with a hypercoagulable state and contributes to venous stasis due to increased intra-abdominal pressure and reduced mobility. - Adipose tissue also produces **pro-inflammatory cytokines** and other factors that promote thrombosis. *Use of the oestrogen-progesterone contraceptive pills* - **Combined oral contraceptive pills** containing oestrogen and progesterone are known to increase the risk of DVT by causing a hypercoagulable state. - Oestrogen can increase the levels of certain **clotting factors** (e.g., factors VII, VIII, X, and fibrinogen) and decrease levels of natural anticoagulants.

Q: Which of the following statements about Sickle Cell Anemia is FALSE?

Patients usually present before the age of 6 months. ***Patients usually present before the age of 6 months*** - This statement is **FALSE** because sickle cell anemia patients typically become symptomatic **after 6 months of age**, when **fetal hemoglobin (HbF)** levels decline. - **HbF is protective** against sickling, so symptoms like **dactylitis** and **splenic sequestration** usually manifest once HbF is replaced by HbS. *There is a positive correlation between HBS and polymerization of HBS* - This statement is **TRUE** as higher levels of **hemoglobin S (HbS)** lead to increased **polymerization** and sickling of red blood cells. - The **polymerization of deoxygenated HbS** is the primary pathophysiologic mechanism causing vaso-occlusive crises and hemolysis. *Recurrent infections is the most common cause of death* - This statement is **TRUE**, particularly in children with sickle cell anemia due to **functional asplenia** from repeated splenic infarctions. - **Splenic dysfunction** impairs clearance of **encapsulated bacteria**, increasing risk of severe infections like **pneumococcal sepsis** and **meningitis**. *Patients require frequent blood transfusions* - This statement is **TRUE** as **chronic transfusion therapy** is a standard treatment for managing severe complications and preventing stroke. - Transfusions help **suppress HbS production**, dilute existing sickle cells, and reduce the frequency of **vaso-occlusive crises**.

Q: In which condition is venous blood most commonly observed to have a high hematocrit in routine clinical practice?

Dehydration. Dehydration - In **dehydration**, the total body water is reduced, leading to a decrease in plasma volume [1, 5]. This concentrates the red blood cells, resulting in a relatively **high hematocrit**. [3] - This is a common finding as the body attempts to conserve fluid, making it a primary cause of **elevated hematocrit** in clinical practice. *Anemia* - **Anemia** is characterized by a decrease in the number of red blood cells or a reduced hemoglobin concentration, which would lead to a **low hematocrit**, not a high one [2]. - This condition involves insufficient oxygen-carrying capacity due to a deficiency in red blood cells or hemoglobin [2]. *Hypervolemia* - **Hypervolemia** describes an excess of fluid in the blood, which would dilute the blood components, leading to a relatively **low hematocrit** [1]. - This condition is often associated with conditions like heart failure or kidney disease, where fluid retention is common. *Acute blood loss* - In **acute blood loss**, the loss of whole blood immediately after the event would initially reduce both red blood cells and plasma proportionally, not immediately raising hematocrit [2]. - As the body attempts to compensate by shifting extravascular fluid into the circulation, this would further dilute the blood, eventually leading to a **decreased hematocrit** [2].

Q: Which condition is commonly associated with Disseminated Intravascular Coagulation (D.I.C.)?

Acute promyelocytic leukemia. ***Acute promyelocytic leukemia*** - **Disseminated Intravascular Coagulation (D.I.C.)** is commonly associated with acute promyelocytic leukemia due to the release of **tissue factor** from promyelocytes [1]. - Patients typically present with **severe bleeding** and coagulopathy [1], driven by the rapid proliferation of these abnormal cells. *Acute myelomonocytic leukemia* - While this type of leukemia presents with myelomonocytic features, it is less frequently associated with **D.I.C.** compared to acute promyelocytic leukemia. - This condition is often characterized by **monocytic infiltration** but does not typically cause the severe coagulopathy associated with D.I.C. *Autoimmune hemolytic anemia* - This condition causes **hemolysis** due to antibodies but is mainly associated with **anemia**, not a coagulation disorder like D.I.C. - **D.I.C.** involves widespread **consumption coagulopathy** [1], which is not a feature of autoimmune hemolytic anemia. *CMC* - CMC refers to **Chronic Myeloid Leukemia**, which does not commonly lead to **D.I.C.** and presents primarily with splenomegaly and **chronic symptoms**. - The coagulation profile in CMC tends to be stable, with no link to the acute coagulopathy seen in D.I.C.

Q: Which of the following conditions is the classic example of acute intravascular hemolysis triggered by oxidative stress?

Acute G6PD deficiency. ***b and c*** - Intravascular hemolysis is commonly associated with both **Acute G6PD deficiency** and **Hereditary spherocytosis**, leading to destruction of red blood cells in the bloodstream [1]. - These conditions are characterized by **high levels of hemoglobinuria** and **low haptoglobin**, indicative of intravascular hemolysis. *Sickle cell ds* - Sickle cell disease primarily causes **extravascular hemolysis** due to splenic sequestration rather than **intravascular** destruction [3]. - The clinical features include **vaso-occlusive crises** and splenic infarction rather than hemolysis within the blood vessels. *Acute G6PD* - While acute G6PD deficiency can lead to hemolysis, it is typically **triggered by oxidative stress** rather than occurring continuously [2]. - The hemolysis in G6PD deficiency occurs more in an **extravascular** manner unless acute stress occurs, which can result in **acute intravascular hemolysis, marked by anemia, hemoglobinemia, and hemoglobinuria** [4]. *Hereditary spherocytosis* - This condition primarily causes **extravascular hemolysis** through the spleen, where abnormal spherocytes are destroyed [1]. - Although it leads to anemia, the hallmark of hereditary spherocytosis is the **spleen's role** in hemocyte destruction rather than intravascular hemolysis.

Q: PNH patients have deficient surface proteins that normally protect red blood cells from activated complements. Which two surface proteins are deficient in these patients?

CD 45 and CD 55. ***CD 55 and CD 59*** - **CD 55 (decay accelerating factor)** and **CD 59 (protectin)** are crucial for inhibiting the complement system, protecting red blood cells from lysis in PNH. - Deficiencies in these proteins lead to increased **susceptibility** of red cells to **complement-mediated hemolysis**. *CD58 and CD 59* - **CD 58** is involved in T-cell interaction but does not solely protect red cells from complement. - While **CD 59** is a correct answer, the absence of **CD 55** makes this option incorrect for PNH. *CD 45 and CD 59* - **CD 45** is primarily a **leukocyte common antigen**, not involved in protecting red cells from complement activation. - This orrectly mentions **CD 59**, but lacks **CD 55**, making it unsuitable as an answer. *CD 51 and CD 59* - **CD 51** is associated with integrin functions and does not play a role in protecting red blood cells from complements. - Although **CD 59** is relevant, the deficiency in **CD 55** highlights the incompleteness of this option.

Question 1

In a severely anaemic pregnant patient presenting with cardiac failure, what is the most appropriate choice of transfusion?

Accepted Answer

Packed cells

Answer

Platelets

Answer

Whole blood

Answer

Exchange transfusion

Question 2

Which of the following conditions does not provide protection against malaria?

Accepted Answer

PNH

Answer

Sickle cell anemia

Answer

Thalassemia

Answer

Duffy blood group

Question 3

Which of the following is not a recognized risk factor for deep vein thrombosis (DVT)?

Accepted Answer

Age less than forty years

Answer

Use of the oestrogen-progesterone contraceptive pills

Answer

Duration of surgery more than thirty minutes

Answer

Obesity

Question 4

Thrombotic thrombocytopenic purpura is a syndrome characterized by which of the following?

Accepted Answer

Thrombocytopenia, anemia, neurological abnormalities, progressive renal failure and fever

Answer

Thrombocytopenia, anemia, neurological abnormalities, progressive hepatic failure and fever

Answer

Thrombocytopenia, normal anemia, neurological abnormalities, progressive renal failure and fever

Answer

Thrombocytopenia, anemia, no neurological abnormalities, progressive renal failure and fever

Question 5

Which of the following statements about Sickle Cell Anemia is FALSE?

Accepted Answer

Patients usually present before the age of 6 months

Answer

There is a positive correlation between HBS and polymerization of HBS

Answer

Recurrent infections is the most common cause of death

Answer

Patients require frequent blood transfusions

Question 6

In which condition is venous blood most commonly observed to have a high hematocrit in routine clinical practice?

Accepted Answer

Dehydration

Answer

Anemia

Answer

Hypervolemia

Answer

Acute blood loss

Question 7

Which condition is commonly associated with Disseminated Intravascular Coagulation (D.I.C.)?

Accepted Answer

Acute promyelocytic leukemia

Answer

Acute myelomonocytic leukemia

Answer

Chronic myeloid leukemia

Answer

Autoimmune hemolytic anemia

Question 8

Which of the following conditions is the classic example of acute intravascular hemolysis triggered by oxidative stress?

Accepted Answer

Acute G6PD deficiency

Answer

Hereditary spherocytosis

Answer

Sickle cell disease

Answer

None of the options

Question 9

PNH patients have deficient surface proteins that normally protect red blood cells from activated complements. Which two surface proteins are deficient in these patients?

Accepted Answer

CD 45 and CD 55

Answer

CD 55 and CD 58

Answer

CD 55 and CD 59

Answer

CD 51 and CD 55

Question 10

Which of the following statements regarding iron supplementation in iron deficiency anemia is incorrect?

Accepted Answer

If gastric intolerance to oral iron therapy occurs, all patients should be administered parenteral forms

Answer

Administer a small diluted dose first prior to infusion to look for any allergy to iron preparation

Answer

Parenteral iron supplementation is required in a patient with Hb of less than 7 mg/dL

Answer

Oral iron therapy should be stopped once the patient achieves a hemoglobin of >12 mg/dL

Hematology — MCQs

Hematology — MCQs

On this page

Practice by Chapter

Want unlimited practice?