Hematology — MCQs

Hematology Indian Medical PG Practice Questions and MCQs

Question 1191: All of the following conditions are associated with Coombs-positive hemolytic anemia, except:

A. SLE
B. Thrombotic Thrombocytopenic Purpura
C. PAN (Correct Answer)
D. Scleroderma

Explanation: ***PAN*** - **Polyarteritis nodosa (PAN)** is a **necrotizing vasculitis** that typically affects medium-sized arteries. It is not generally associated with Coombs-positive hemolytic anemia. - While systemic inflammation can cause anemia of chronic disease, direct autoantibody-mediated red blood cell destruction is not a feature of PAN. *Thrombotic Thrombocytopenic Purpura* - **Thrombotic thrombocytopenic purpura (TTP)** is characterized by microangiopathic hemolytic anemia, but it is typically **Coombs-negative** [3]. - The hemolysis in TTP is due to mechanical fragmentation of red blood cells as they pass through fibrin networks in small vessels, not antibody-mediated destruction [3]. *Scleroderma* - **Systemic sclerosis (scleroderma)** can be associated with autoimmune phenomena including **autoimmune hemolytic anemia**, which can be Coombs-positive [2]. - While less common than in SLE, autoimmune hemolytic anemia is a recognized complication in some patients with scleroderma due to immune dysregulation [2], [3]. *SLE* - **Systemic lupus erythematosus (SLE)** is frequently associated with **Coombs-positive hemolytic anemia** [1]. - **Autoantibodies** against red blood cell surface antigens are common in SLE, leading to their destruction by the immune system [1], [2].

Question 1192: Disseminated intravascular coagulation (DIC) differs from thrombotic thrombocytopenic purpura. In this reference, DIC is most likely characterized by:

A. Elevated reticulocyte count
B. Low levels of coagulation factors (Correct Answer)
C. Severe thrombocytopenia
D. Presence of schistocytes in the blood smear

Explanation: ***Decreased coagulation factor levels*** - DIC is characterized by an activation of the coagulation cascade, leading to increased consumption of **coagulation factors** and resulting in low levels [1]. - This process causes a paradoxical increased risk of bleeding despite a **consumption coagulopathy** scenario [1]. *Significant thrombocytopenia* - While thrombocytopenia can occur in DIC, it is not as pronounced as in **thrombotic thrombocytopenic purpura** (TTP), which features **severe thrombocytopenia** as its hallmark [2]. - DIC typically presents with **variable platelet counts**, often fluctuating based on the underlying cause. *A brisk reticulocytosis* - Reticulocytosis is common in hemolytic processes, but it is not a defining characteristic of DIC, which primarily involves dysfunction in the **coagulation cascade** rather than increased red blood cell production. - In contrast, TTP may show reticulocytosis due to hemolysis, but this does not apply directly to DIC. *Significant numbers of schistocytes* - Schistocytes are seen in microangiopathic hemolytic anemias, but **quantity and significance** vary; they may not be prominently present in DIC cases compared to TTP, which is distinguished by more pronounced schistocytes [2]. - DIC primarily leads to a **consumption coagulopathy**, whereas schistocytes more specifically indicate **mechanical hemolysis** [2].

Question 1193: Which of the following conditions is not associated with hemolytic anemia?

A. Hemosiderosis
B. Hemochromatosis (Correct Answer)
C. Cholelithiasis
D. None of the options

Explanation: ***None of the above*** - Hemolytic anemia can lead to various complications, but this option indicates that all listed options are seen in the condition, which is incorrect. - Therefore, saying "None of the above" about this particular question is a misinterpretation of the options provided. *Cholelithiasis* - This is a common complication due to increased **bilirubin** levels from hemolysis, leading to the formation of **bilirubinate gallstones**. - It can frequently be seen in cases of hemolytic anemia, particularly if there's chronic hemolysis, such as in hereditary spherocytosis [1]. *Hemosiderosis* - This condition occurs when there is excess **iron deposition**, often due to repeated blood transfusions in conditions like thalassemia or sideroblastic anemia. - While patients with hemolytic anemia can develop it due to frequent transfusions, it is not an inherent feature of hemolytic anemia itself. Intravascular hemolysis is specifically associated with haemosiderinuria [2]. *Hemochromatosis* - Hemochromatosis is a hereditary condition causing excess iron absorption and storage, which is distinct from the iron overload seen in hemosiderosis. - Hemolytic anemia does not lead to hemochromatosis directly; hence, it is not a typical finding associated with hemolytic anemia. Other syndromes like hemolytic-uremic syndrome specifically characterize certain hemolytic presentations [3].

Question 1194: What is a known complication of Parvovirus B19 infection?

A. Erythema infectiosum
B. Arthritis
C. Aplastic anemia (Correct Answer)
D. All of the options

Explanation: Aplastic anemia - Parvovirus B19 has a tropism for erythroid progenitor cells in the bone marrow, specifically targeting and destroying them [1]. - This destruction can lead to a transient aplastic crisis, especially in individuals with pre-existing hemolytic conditions, causing a severe drop in red blood cell production [1]. Erythema infectiosum - This is the most common clinical manifestation of Parvovirus B19 infection, also known as fifth disease, characterized by a "slapped cheek" rash [1]. - While it is a symptom or disease caused by the virus, it is not considered a complication in the sense of a secondary, adverse outcome. Arthritis - Arthralgia and arthritis are common manifestations of Parvovirus B19 infection, particularly in adults, especially women [1]. - Similar to erythema infectiosum, it is a direct clinical manifestation rather than a "complication" representing a secondary, undesirable event. All of the options - While erythema infectiosum and arthritis are common clinical presentations of Parvovirus B19, they are direct disease manifestations. - Aplastic anemia stands out as a true complication, representing a secondary and potentially severe adverse outcome due to the virus's specific cellular tropism [1].

Question 1195: Which of the following is the LEAST likely indication for intravenous iron administration?

A. Inability to Tolerate oral Iron
B. Iron malabsorption
C. Patients on Erythropoietin Therapy (Correct Answer)
D. Intermittent Gastrointestinal blood loss

Explanation: ### Patients on Erythropoietin Therapy - While patients on **erythropoietin therapy** often require iron supplementation, **oral iron** is usually the first-line choice if tolerated. IV iron is primarily reserved for those who cannot absorb or tolerate oral iron, or have severe iron deficiency, not merely for being on erythropoietin [2]. - The need for iron in this setting is due to the increased demand for red blood cell production, but the route depends on other factors like significant deficiency or inability to use oral routes. *Iron malabsorption* - **Iron malabsorption** prevents adequate iron uptake from the GI tract, making oral iron ineffective [2]. - **Intravenous iron** bypasses the gastrointestinal system, ensuring effective delivery of iron to the body. *Inability to Tolerate oral Iron* - Patients who experience significant **gastrointestinal side effects** (nausea, constipation, diarrhea) from oral iron often cannot adhere to therapy. - **Intravenous iron** avoids these GI side effects, providing an alternative route for necessary iron supplementation. *Intermittent Gastrointestinal blood loss* - **Intermittent GI blood loss** can lead to chronic iron deficiency that is difficult to replete with oral iron alone due to ongoing losses [1, 3]. - **Intravenous iron** can rapidly replenish iron stores and compensate for continuous or significant blood loss more effectively than oral supplementation.

Question 1196: Which of the following are the features of pernicious anemia?

A. Gastric mucosal atrophy
B. Subacute combined degeneration of spinal cord
C. Hyper-segmented neutrophils
D. All of the options (Correct Answer)

Explanation: ***All of the above*** - Pernicious anemia features include various manifestations like **gastric mucosal atrophy**, **hyper-segmented neutrophils**, and **subacute combined degeneration of the spinal cord**. - It is an autoimmune condition leading to **vitamin B12 deficiency** [1], affecting multiple systems, confirming that all stated features are relevant. *Subacute combined degeneration of spinal cord* - While this condition is seen in **vitamin B12 deficiency**, it is not exclusive to pernicious anemia, as it can occur in **various causes** of B12 deficiency [1]. - The direct link to pernicious anemia is more about **gastric atrophy** and resultant malabsorption rather than spinal cord degeneration itself. *Gastric mucosal atrophy* - Gastric mucosal atrophy is a key feature of pernicious anemia but does not encompass the complete spectrum of its clinical implications. - This condition causes reduced **intrinsic factor production**, leading to vitamin B12 deficiency [1], thus confirming it is part but not all of the features. *Hyper-segmented neutrophils* - Hyper-segmented neutrophils are notably found in megaloblastic anemia due to B12 deficiency [1] but do not exclusively indicate pernicious anemia. - Their presence alone lacks specificity, as they can also arise in **folate deficiency** or other causes of megaloblastic anemia.

Question 1197: The most common bleeding manifestation of Hemophilia is

A. Hemarthrosis (Correct Answer)
B. Hematuria
C. Hemoptysis (coughing up blood)
D. Hematomas (bleeding into soft tissues)

Explanation: ***Hemarthrosis*** - Characterized by **bleeding into joint spaces**, leading to pain, swelling, and reduced mobility, commonly seen in Hemophilia [1]. - Occurs due to deficiency of clotting factors, resulting in joint bleeding with minimal trauma [1]. *Hematuria* - Refers to the presence of **blood in urine**, which is often associated with **urinary tract conditions**, not primarily Hemophilia. - While it can occur in hemophilia patients, it is less characteristic of Hemophilia compared to hemarthrosis. *Hematomas* - These are localized collections of **blood outside of blood vessels**, typically resulting from blunt trauma or injury. - Although they can occur in Hemophilia as soft tissue hemorrhage [1], they are not as specific as hemarthrosis for bleeding manifestations. *Hemoptysis* - Defined as coughing up **blood**, which usually indicates pulmonary or vascular conditions rather than a bleeding disorder like Hemophilia. - It is not a common manifestation of Hemophilia, which primarily presents with joint and muscle bleeding [1].

Question 1198: An 18-year-old man recently diagnosed with beta-thalassemia minor has a hemoglobin level of 10.5 g/dL and feels well. Which of the following findings is characteristic of this condition?

A. an increased amount of fetal hemoglobin (HbF) and hemoglobin A2 (HbA2) (Correct Answer)
B. increased osmotic fragility of red blood cells
C. normal bone marrow iron stores
D. increased macroglobulins in the serum

Explanation: ***an increased amount of fetal hemoglobin (HbF) and hemoglobin A2 (HbA2)*** - Beta-thalassemia minor is characterized by a reduced synthesis of the **beta-globin chain**, leading to a relative increase in the proportions of **HbA2** and sometimes **HbF** as compensatory mechanisms [1]. - An elevated **HbA2** level, typically above 3.5%, is the **hallmark diagnostic feature** for beta-thalassemia trait/minor. *increased osmotic fragility of red blood cells* - **Increased osmotic fragility** is characteristic of conditions like **hereditary spherocytosis**, where red blood cells are more susceptible to lysis in hypotonic solutions [2]. - In beta-thalassemia, red blood cells are typically **microcytic and hypochromic** but do not usually show increased osmotic fragility; in fact, they may have *decreased* fragility due to structural changes. *normal bone marrow iron stores* - In thalassemia syndromes, a primary issue is defective globin synthesis, not iron deficiency; thus, **bone marrow iron stores are typically normal or even increased** due to ineffective erythropoiesis and repeated transfusions (in severe cases). - This contrasts with **iron deficiency anemia**, where bone marrow iron stores would be depleted, making this option incorrect as a *characteristic* differentiator of beta-thalassemia minor from other anemias where iron stores can be affected. *increased macroglobulins in the serum* - **Increased macroglobulins** (e.g., IgM antibodies) in the serum is characteristic of conditions like **Waldenström macroglobulinemia**, a type of B-cell lymphoma. - This finding has **no direct association** with beta-thalassemia minor, which is an inherited disorder of hemoglobin synthesis.

Question 1199: Which of the following is a better indicator for transfusion?

A. Skin color
B. Physical examination
C. Hematocrit level (Correct Answer)
D. Urine output

Explanation: Hematocrit level - The **hematocrit level** directly measures the proportion of **red blood cells** in the blood, providing an objective indicator of oxygen-carrying capacity. - A low or rapidly falling hematocrit level is a critical **quantitative parameter** often used in transfusion guidelines, especially in the context of acute blood loss or symptomatic anemia. *Skin color* - **Skin color** is a subjective and often unreliable indicator of anemia or the need for transfusion, as pallor can be influenced by many factors [1]. - It does not provide a **quantitative measure** of blood loss or oxygen-carrying capacity. *Physical examination* - While a physical examination can reveal symptomatic anemia (e.g., pallor, tachycardia, orthostatic hypotension), it is a **qualitative assessment** and does not precisely quantify blood loss or oxygen demand [1]. - It should always be complemented by **laboratory tests** to guide transfusion decisions. *Urine output* - **Urine output** is an indicator of **renal perfusion** and overall hydration status, which can be affected by blood volume, but it is not a direct measure of anemia or the need for red blood cell transfusion [2]. - A decreased urine output might suggest hypovolemia or shock, but it doesn't specify if the underlying cause requires **red blood cell replacement** versus fluid resuscitation.

Question 1200: Thrombotic event is seen in all of the following except:

A. Heparin induced thrombocytopenia
B. Disseminated intravascular coagulation
C. Idiopathic thrombocytopenic purpura (Correct Answer)
D. Paroxysmal nocturnal hemoglobinuria

Explanation: ***Immune thrombocytopenic purpura*** - This condition primarily results in **thrombocytopenia**, leading to increased bleeding rather than thrombotic events [1][3]. - Patients typically present with **petechiae** and **purpura**, without the thrombotic complications seen in other conditions [1][3]. *Paroxysmal nocturnal hemoglobinuria* - Characterized by **hemolysis** and a risk of **thrombosis**, particularly in large veins. - Associated with **bone marrow** dysregulation, leading to increased blood viscosity and thrombotic events. *Heparin induced thrombocytopenia* - This condition leads to **thrombocytopenia** and paradoxically **increased thrombosis**, not bleeding. - It is caused by an immune response to heparin, resulting in the activation of platelets. *Disseminated intravascular coagulation* - Involves excessive clotting followed by a risk of bleeding due to **consumption of clotting factors** [1][2]. - Thrombotic events are common, with widespread small thrombi leading to organ dysfunction [2].

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Anemia Evaluation and Management

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Hemoglobinopathies

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Thalassemias

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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

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Myeloproliferative Neoplasms

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Transfusion Medicine

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Hematopoietic Stem Cell Transplantation

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Hematology — MCQs

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