Hematology Practice Questions

Q: Which of the following conditions is primarily associated with stasis as a cause of thrombosis?

Venous stasis. ***All of the above*** - Stasis can contribute to **thrombosis in various conditions**, including polycythemia, as it increases blood viscosity, and in sickle cell anemia due to impaired blood flow [2]. - **Venous circulation** is particularly affected by stasis, as it leads to venous thromboembolism, making it a critical factor in thrombosis [1]. *Polycythemia* - While **polycythemia** leads to increased blood viscosity, stasis itself isn't the primary mechanism for thrombosis in this condition. - Thrombosis in polycythemia is more due to *hyperviscosity* rather than stasis alone. *Venous circulation* - While stasis is indeed significant in **venous circulation**, it does not capture the full spectrum of thrombosis causes in the context of various conditions [1]. - Other factors such as **hypercoagulability** and **vascular injury** also contribute, making it not solely reliant on stasis [1]. *Sickle cell Anemia* - Thrombosis in sickle cell anemia occurs mainly due to **occlusion** from sickled cells, rather than stasis leading to thrombus formation [2]. - While stasis can occur, it is not the principal cause of thrombosis in this disease [2].

Q: All are true regarding lupus anticoagulant except?

Thrombocytosis. ***Thrombocytosis*** - **Lupus anticoagulant** is associated with an **increased risk of thrombosis**, but it does not directly cause thrombocytosis (an elevated platelet count). - Patients with **antiphospholipid syndrome**, which involves lupus anticoagulant, can have normal or even low platelet counts (**thrombocytopenia**). [1] *Increased antibodies* - **Lupus anticoagulant** is an **autoantibody** (specifically, an antiphospholipid antibody) that interferes with coagulation tests in vitro, but it is associated with an increased risk of thrombosis in vivo. - The presence of this antibody is a key diagnostic criterion for **antiphospholipid syndrome**. *Rashes* - **Lupus anticoagulant** is often found in patients with **systemic lupus erythematosus (SLE)**, a condition known for various skin manifestations, including characteristic rashes (e.g., **malar rash**, discoid rash). [1] - While not directly caused by lupus anticoagulant, it is highly associated given the overlap between **SLE and antiphospholipid syndrome**. *Arterial thrombosis* - **Lupus anticoagulant** is a significant risk factor for both **arterial and venous thrombosis**, leading to complications like strokes, myocardial infarctions, and peripheral arterial occlusions. - It contributes to a **prothrombotic state** by activating endothelial cells and interfering with natural anticoagulant pathways.

Q: Mr. Lallu, aged 54 years, who is a known diabetic patient, develops cirrhosis. There is associated skin hyperpigmentation and restrictive cardiomyopathy. Which of the following is the best initial test to diagnose this case?

Serum ferritin. ***Serum ferritin*** - Elevated **serum ferritin** is an excellent initial screening test for **hemochromatosis** due to its direct correlation with iron stores [1]. - The constellation of **cirrhosis**, **diabetes**, **skin hyperpigmentation**, and **restrictive cardiomyopathy** strongly points to hemochromatosis, a disorder of excessive iron accumulation [2]. *Serum ceruloplasmin* - This test is primarily used for diagnosing **Wilson's disease**, which involves copper accumulation, not iron. - While Wilson's can cause cirrhosis, the other symptoms (diabetes and skin hyperpigmentation) are not typical for this condition. *Serum copper* - **Serum copper** is another test for Wilson's disease or other copper metabolism disorders. - It does not directly assess iron stores and would not be the best initial test for suspected hemochromatosis. *Iron binding capacity* - **Total iron-binding capacity (TIBC)** measures the blood's capacity to bind iron, primarily reflecting transferrin levels. - While relevant to iron metabolism, **serum ferritin** is a more sensitive and specific initial screening test for diagnosing iron overload in hemochromatosis.

Q: A 20-year-old male presented with fatigue, weakness, and jaundice. What is the most likely diagnosis?

Acute myeloid leukemia. ***Acute myeloid leukemia*** - Presents with **fatigue** and **weakness** due to bone marrow infiltration and resultant cytopenias, typical in this age group [1]. - Often shows **myeloblasts** on peripheral blood smear, confirming the diagnosis [2]. *Chronic myeloid leukemia* - Usually occurs in **older adults** and characterized by **elevated white blood cell counts** with a predominance of mature neutrophils. - Symptoms like fatigue may arise, but there are distinct **Philadelphia chromosome** findings and typically a **longer symptom duration**. *Acute lymphoblastic leukemia* - More common in **younger children** and often associated with **lymphadenopathy** and **thrombocytopenia**, rather than fatigue alone. - Characteristically shows **lymphoblasts** in the blood, which are not mentioned in this patient's presentation. *Chronic lymphocytic leukemia* - Typically presents in adults over **50 years** and is characterized by **lymphocytosis** and often asymptomatic in early stages. - Fatigue may occur but lacks the acute presentation and findings seen in **acute leukemias**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 607-608. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 621-622.

Q: A 25-year-old lady on treatment for rheumatoid arthritis has the following laboratory findings: hemoglobin of 9 g/dL, mean corpuscular volume of 55 fl, serum iron of 30 μg/dL, ferritin of 200 ng/mL, and total iron-binding capacity of 298 μg/dL. What is the most probable diagnosis?

Thalassemia minor. **Thalassemia minor** - The combination of **microcytic anemia (MCV 55 fL)**, **low serum iron (30 μg/dL)**, **normal to elevated ferritin (200 ng/mL)**, and a **normal-to-high total iron-binding capacity (298 μg/dL)** suggests a condition where iron stores are adequate but incorporation into hemoglobin is impaired. - This is characteristic of **thalassemia trait**, where genetic defects lead to reduced synthesis of globin chains despite sufficient iron, causing microcytic, hypochromic red blood cells. *Thalassemia major* - Patients with **thalassemia major** typically present with severe anemia requiring frequent transfusions and would likely have much lower hemoglobin levels and often associated with markers of severe hemolysis. - While it causes **microcytic anemia**, the clinical picture and iron studies (especially relatively high ferritin and only moderately low hemoglobin) are less consistent with overt thalassemia major. *Anemia of chronic disease* - **Anemia of chronic disease (ACD)** typically presents with **normal or elevated ferritin** and a **low serum iron**, but usually has a **normal MCV** (normocytic anemia) or, sometimes, mild microcytosis [1]. - The MCV of 55 fL is too low to be classic ACD, and typically TIBC would be low in ACD due to inflammation [2]. *Iron deficiency anemia* - **Iron deficiency anemia** typically presents with **low serum iron**, **low ferritin**, and a **high total iron-binding capacity** due to the body's attempt to absorb more iron [2]. - The **elevated ferritin (200 ng/mL)** in this case makes isolated iron deficiency anemia highly unlikely, as ferritin is a measure of iron stores.

Q: Bone marrow biopsy is absolutely indicated in which of the hematological conditions?

Hairy cell leukemia. ***Hairy cell leukemia*** - A **bone marrow biopsy** is absolutely indicated for diagnosis due to the characteristic **fibrosis** that often prevents a diagnostic aspirate. - The biopsy can reveal infiltration by "hairy cells" and assess the extent of disease and **myelofibrosis**. *Acute leukemia* - While bone marrow examination (aspirate and biopsy) is crucial for diagnosing **acute leukemia**, an aspirate is often sufficient for initial diagnosis and classification. - Biopsy provides additional information on cellularity and architecture, but the diagnosis can often be made on the aspirate. *Megaloblastic anemia* - Diagnosis primarily relies on **peripheral blood smears** showing macro-ovalocytes and hypersegmented neutrophils, along with **serum vitamin B12** and **folate levels**. - A bone marrow aspirate can show **megaloblastic erythroid and myeloid hyperplasia**, but it is generally not an absolute indication for diagnosis. *Thalassemia* - Diagnosis of **thalassemia** is primarily based on **hemoglobin electrophoresis**, genetic testing, and peripheral blood indices (microcytic, hypochromic anemia). - Bone marrow examination is usually not required for diagnosis, though it may show erythroid hyperplasia.

Q: A middle-aged male presented with a history of fatigue and tiredness. On investigation, he had a hemoglobin level of 8 g/dL and a mean corpuscular volume (MCV) of 110 fl, with the peripheral smear showing macrocytes and hypersegmented neutrophils. Which of the following is the most likely cause of these findings in this patient?

Chronic alcohol use. ***Chronic alcoholism*** - **Macrocytic anemia** with a **hemoglobin level of 8 g/dL** is commonly seen in chronic alcoholism due to impaired erythropoiesis and folate deficiency. [1] - The **peripheral smear** showing **hypersegmented neutrophils** is indicative of megaloblastic anemia, often linked to **alcoholism**. [1] *Chronic renal failure* - Typically causes **normocytic anemia** due to inadequate erythropoietin production, not macrocytic anemia. [2] - While uremic effects can impact erythropoiesis, they usually do not produce **hypersegmented neutrophils** found in megaloblastic anemia. *Colon cancer* - More commonly causes **microcytic anemia** due to **iron deficiency** from chronic blood loss rather than macrocytic anemia. [2] - **Macrocytic anemia** with hypersegmented neutrophils would not be expected in most cases of colon cancer. *Ancylostoma duodenale infestation* - This hookworm infection typically leads to **microcytic anemia** due to **iron deficiency**, not macrocytic. [2] - The presence of **macrocytes** and **hypersegmented neutrophils** does not correlate with this type of anemia.

Q: Hemolytic anemia is associated with which gallstones?

Pigmented. ***Pigmented*** - **Pigmented gallstones** (specifically black pigment stones) are associated with hemolytic anemia due to increased **unconjugated bilirubin** production [1]. - The excess bilirubin is excreted into bile, where it polymerizes with calcium to form insoluble calcium bilirubinate, leading to stone formation [1]. *Cholesterol* - **Cholesterol gallstones** are the most common type and are primarily formed from supersaturated cholesterol in bile [1]. - Their formation is not directly linked to conditions causing increased bilirubin production, such as **hemolytic anemia**. *Mixed* - **Mixed gallstones** contain both cholesterol and calcium bilirubinate but are predominantly cholesterol [1]. - While they may contain some pigment, their primary etiology is related to gallbladder stasis and cholesterol supersaturation, not typically **hemolysis**. *None of the options* - This option is incorrect because **pigmented gallstones** are strongly associated with hemolytic anemia.

Question 1

Which of the following conditions is primarily associated with stasis as a cause of thrombosis?

Accepted Answer

Venous stasis

Answer

Polycythemia

Answer

Dehydration

Answer

Sickle cell anemia

Question 2

All are true regarding lupus anticoagulant except?

Accepted Answer

Thrombocytosis

Answer

Arterial thrombosis

Answer

Increased antibodies

Answer

Rashes

Question 3

Mr. Lallu, aged 54 years, who is a known diabetic patient, develops cirrhosis. There is associated skin hyperpigmentation and restrictive cardiomyopathy. Which of the following is the best initial test to diagnose this case?

Accepted Answer

Serum ferritin

Answer

Serum ceruloplasmin

Answer

Serum copper

Answer

Iron binding capacity

Question 4

A 20-year-old male presented with fatigue, weakness, and jaundice. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Acute lymphoblastic leukemia

Answer

Chronic myeloid leukemia

Answer

Chronic lymphocytic leukemia

Question 5

A 25-year-old lady on treatment for rheumatoid arthritis has the following laboratory findings: hemoglobin of 9 g/dL, mean corpuscular volume of 55 fl, serum iron of 30 μg/dL, ferritin of 200 ng/mL, and total iron-binding capacity of 298 μg/dL. What is the most probable diagnosis?

Accepted Answer

Thalassemia minor

Answer

Thalassemia major

Answer

Iron deficiency anemia

Answer

Anemia of chronic disease

Question 6

Which of the following statements about cold agglutinin disease is false?

Accepted Answer

Rituximab is not effective as a therapeutic measure as it can not control hemolysis effectively

Answer

The antibody is usually IgM with an anti-I specificity

Answer

Blood transfusion is not very effective because donor red cells are I-positive and will be rapidly removed

Answer

Hemolysis is more prominent the more the body is exposed to the cold

Question 7

Which of the following statements is true regarding von Willebrand disease?

Accepted Answer

Bleeding time is prolonged due to impaired platelet adhesion.

Answer

Factor VIII levels are always normal.

Answer

Platelet count is consistently decreased.

Answer

Activated partial thromboplastin time (aPTT) is always normal.

Question 8

Bone marrow biopsy is absolutely indicated in which of the hematological conditions?

Accepted Answer

Hairy cell leukemia

Answer

Acute leukemia

Answer

Megaloblastic anemia

Answer

Thalassemia

Question 9

A middle-aged male presented with a history of fatigue and tiredness. On investigation, he had a hemoglobin level of 8 g/dL and a mean corpuscular volume (MCV) of 110 fl, with the peripheral smear showing macrocytes and hypersegmented neutrophils. Which of the following is the most likely cause of these findings in this patient?

Accepted Answer

Chronic alcohol use

Answer

Ancylostoma duodenale infection

Answer

Chronic kidney disease

Answer

Colorectal cancer

Question 10

Hemolytic anemia is associated with which gallstones?

Accepted Answer

Pigmented

Answer

Cholesterol

Answer

Mixed

Answer

None of the options

Hematology — MCQs

Hematology — MCQs

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