Hematology Practice Questions

Q: Which of the following statements are correct regarding iron deficiency? 1. More common in older age group 2. More common in females of reproductive age 3. Associated with heavy menstrual bleeding 4. Commonly caused by chronic blood loss Select the correct answer using the code given below.

1, 2 and 4. ***1, 2 and 4*** * **Iron deficiency** is indeed more common in **older age groups**, often due to decreased dietary intake, malabsorption, or chronic diseases [1], [3]. * It is also frequently observed in **females of reproductive age**, primarily due to physiological iron loss through menstruation [2]. * **Chronic blood loss** from various sources, such as gastrointestinal bleeding [1] or heavy menstruation [2], is a very common cause of iron deficiency [3]. *1, 2 and 3* * While iron deficiency is common in older age groups and females of reproductive age, the statement that it is *only* associated with heavy menstrual bleeding isn't comprehensive enough, as chronic blood loss is a broader and more common cause [1]. * Though heavy menstrual bleeding is a significant cause of iron deficiency in women, this option omits chronic blood loss as a more general and equally important cause. *2, 3 and 4* * This option incorrectly implies that iron deficiency is *not* more common in older age groups, which is a known demographic at risk [3]. * While **heavy menstrual bleeding** and **chronic blood loss** are major causes, excluding the increased prevalence in older populations makes this option incomplete. *1, 3 and 4* * This option inaccurately suggests that iron deficiency is *not* more common in females of reproductive age, which is a key demographic for iron deficiency due to menstrual blood loss [2]. * It correctly identifies chronic blood loss and heavy menstrual bleeding as causes but misses a significant demographic for prevalence.

Q: Which of the following statements are correct in respect of haemophilia? 1. It is hereditary bleeding disorder. 2. It has a higher incidence among Asians. 3. It affects females occasionally and mildly.

1 and 3 only. ***1 and 3 only*** - Haemophilia is a well-known **hereditary bleeding disorder**, primarily affecting males, caused by a deficiency in certain clotting factors [1]. - While haemophilia mainly affects males, females can be carriers and, in rare instances, experience mild to moderate symptoms, especially due to **extreme X-inactivation**. *2 and 3 only* - The statement that it has a higher incidence among Asians is **incorrect**; haemophilia incidence is generally consistent across ethnic groups, approximately 1 in 5,000 live male births worldwide [2]. - While females can be affected, their involvement is typically mild and occasional, making statement 3 correct. *1 and 2 only* - Haemophilia is indeed a **hereditary bleeding disorder** (statement 1 is correct) [1]. - However, the claim of higher incidence among Asians is **unsupported** by epidemiological data, rendering statement 2 incorrect. *1, 2 and 3* - While haemophilia is a **hereditary bleeding disorder** and can affect females, the assertion of a higher incidence among Asians is **false** [2]. - Its global incidence rates do not show a significant racial or ethnic predilection.

Q: The following are the common features of Idiopathic Thrombocytopenic Purpura except

Massive splenomegaly. ***Massive splenomegaly*** - Idiopathic Thrombocytopenic Purpura (ITP) typically involves only **mild to moderate splenomegaly**, if any, due to increased platelet destruction in the spleen [1]. **Massive splenomegaly** is not a characteristic feature. - **Massive splenomegaly** would suggest other conditions like chronic myeloid leukemia, myelofibrosis, or certain infectious diseases. *Cutaneous ecchymoses* - **Ecchymoses (bruising)** are a common symptom of ITP due to the low platelet count, leading to easier bleeding under the skin [2]. - These present as larger, purplish patches on the skin, indicating extravasated blood. *Thrombocytopenia* - **Thrombocytopenia** (low platelet count) is the hallmark and diagnostic criterion for ITP [1]. - The reduced number of platelets impairs the body's ability to form clots, leading to bleeding manifestations [2]. *Epistaxis* - **Epistaxis (nosebleeds)** is a common mucocutaneous bleeding symptom in ITP, reflecting the impaired primary hemostasis due to low platelet count [2]. - Bleeding from mucosal surfaces is typical in platelet disorders [2].

Q: Priapism in a young male could occur because of

leukaemia. ***Leukaemia*** - In leukaemia, especially **myeloid leukaemia**, immature white blood cells can accumulate in the **corpus cavernosa**, leading to stasis and **venous occlusion**. [1] - This cellular congestion prevents venous outflow from the penis, causing a prolonged and **painful erection (priapism)**. *Carcinoid tumour of appendix* - A carcinoid tumour of the appendix is typically associated with **carcinoid syndrome**, which involves symptoms like flushing and diarrhoea. - It does **not directly cause priapism**, as its mediators (e.g., serotonin) do not typically induce this specific local vascular event. *Testicular cancer* - Testicular cancer primarily manifests as a **painless lump in the testis** and can cause symptoms related to metastasis, but **priapism is not a typical direct presenting symptom**. - While some cancers can cause paraneoplastic syndromes, testicular cancer is not associated with priapism. *Penile cancer* - Penile cancer typically presents as a **lesion, ulcer, or mass on the penis**, often associated with pain, bleeding, or discharge. - While it affects the penis, it does **not typically cause prolonged erections (priapism)**, but rather local tissue destruction or obstruction.

Q: Umbilical cord blood stem cells are used to treat all the following diseases except :

Parkinsonism. ***Parkinsonism*** - While stem cell research for Parkinson's disease is ongoing, current treatments using **umbilical cord blood stem cells** have not shown efficacy or routine use for this neurodegenerative disorder. - Parkinson's disease primarily affects **dopaminergic neurons** in the substantia nigra, which are not effectively replaced or regenerated by umbilical cord blood stem cells in a therapeutic context. *Leukemia* - **Umbilical cord blood stem cells** are a well-established source of **hematopoietic stem cells** used in transplantation to treat various forms of leukemia. - These stem cells can engraft in the bone marrow and differentiate into healthy blood cells, replacing cancerous cells after chemotherapy or radiation. *Osteoporosis* - Research is exploring the use of **mesenchymal stem cells** from umbilical cord blood for bone regeneration and treatment of osteoporosis. - These stem cells have the potential to differentiate into **osteoblasts**, which are essential for bone formation and repair. *Diabetes* - Experimental treatments and clinical trials are investigating the use of **umbilical cord blood stem cells** to treat Type 1 Diabetes by modulating the immune system and potentially regenerating insulin-producing beta cells. - The immunomodulatory properties of these stem cells may help in preventing the autoimmune destruction of **pancreatic beta cells**.

Q: A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Hereditary spherocytosis. ***Hereditary spherocytosis*** - The combination of **recurrent abdominal pain**, **jaundice**, **reticulocytosis**, and **hyperbilirubinemia** is highly suggestive of hereditary spherocytosis, which causes chronic hemolytic anemia [1, 3]. - **Jaundice** and **abdominal pain** can result from pigment gallstones (due to chronic hemolysis) and splenic enlargement, both common in this condition [2, 3]. *Mirizzi's syndrome* - Characterized by **extrinsic compression of the common hepatic duct** by a stone impacted in the cystic duct or gallbladder neck. - While it causes jaundice and abdominal pain, it does not typically present with **reticulocytosis** or **hemolysis** [1]. *Sclerosing cholangitis* - A chronic cholestatic liver disease characterized by **inflammation and fibrosis** of the bile ducts. - While it causes jaundice and abdominal pain, it is not associated with **reticulocytosis** or signs of **hemolysis** [1]. *Choledochal cyst* - A **congenital dilation of the bile ducts**, leading to recurrent abdominal pain, jaundice, and a palpable mass. - It does not involve **hemolysis** or **reticulocytosis**, making it less likely in this context.

Q: Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Flow cytometry is the best investigation. ***Flow cytometry is the best investigation*** - **Flow cytometry** is the gold standard for diagnosing PNH as it directly detects the absence of **GPI-anchored proteins (CD55 and CD59)** on the surface of red blood cells, granulocytes, and monocytes. - This method is highly sensitive and specific, allowing for the precise quantification of PNH clones even when present in small numbers. *Sucrose lysis test is used for the confirmation* - The **sucrose lysis test** (or sugar-water test) was an older screening test for PNH, but it is **not specific or sensitive enough** for confirmation. - It works by inducing complement activation on PNH cells in low ionic strength sucrose solution [1], but it has a high rate of false positives and negatives. *The most common cause of death is heart failure* - The most common cause of death in patients with PNH is **thrombosis**, particularly in unusual sites such as hepatic, cerebral, or abdominal veins, due to the prothrombotic state caused by the disease. - While heart complications can occur, they are not the leading cause of mortality. *It is an inherited disorder* - PNH is an **acquired clonal disorder** of hematopoietic stem cells, not an inherited genetic disorder [1]. - It results from a somatic mutation in the **PIG-A gene** in a hematopoietic stem cell, leading to the deficiency of GPI-anchored proteins.

Q: An 18-year-old male presents to the OPD with gum bleeding, fever, low total leukocyte count (TLC), and low platelet count. General examination is unremarkable. Further investigations reveal a low reticulocyte count, absent megakaryocytes, and no immature cells in the bone marrow. What is the most likely diagnosis?

Aplastic anemia. ***Aplastic anemia*** - This condition is characterized by **pancytopenia** (low TLC and platelet count, implied low red blood cell count by low reticulocyte count) due to **bone marrow failure**. - The absence of **megakaryocytes** and other immature cells in the bone marrow confirms the **hypocellularity** typical of aplastic anemia. *Immune Thrombocytopenic Purpura (ITP)* - While ITP presents with **low platelet count** and potential gum bleeding [1], the bone marrow typically shows **normal or increased megakaryocytes**. - ITP does not explain the **low total leukocyte count** or low reticulocyte count seen in this patient [1]. *Myelodysplastic Syndrome (MDS)* - MDS involves **ineffective hematopoiesis** and can present with cytopenias, but the bone marrow is usually **hypercellular or normocellular** with dysplastic changes. - The absence of immature cells and overall hypoplasia does not fit the typical picture of MDS. *Acute Myeloid Leukemia (AML)* - AML is characterized by an overproduction of **immature myeloid cells (blasts)** [3], which are conspicuously absent in this patient's bone marrow description. - While AML can cause pancytopenia, the presence of **immature cells** in the bone marrow is its hallmark [3]. Gum hypertrophy is also a common clinical sign in AML [2].

Q: Which of the following is considered a poor prognostic marker in multiple myeloma (MM)?

B2 microglobulins. ***B2 microglobulins*** - Elevated levels of **B2 microglobulin** are a significant indicator of increased tumor burden and are used in the **International Staging System (ISS)** for multiple myeloma, correlating with shorter survival [1]. - This protein is present on the surface of most nucleated cells and its accumulation reflects **renal impairment** or increased cell turnover. *Serum Creatinine* - While elevated **serum creatinine** can indicate **renal insufficiency**, a common complication in MM, it is not a direct measure of tumor burden or aggression in the same way as B2 microglobulin [1]. - **Renal failure** can be a poor prognostic factor in MM, but creatinine itself is a marker of organ damage rather than disease progression or malignancy. *Hypercalcemia* - **Hypercalcemia** is a common complication in MM due to increased **bone resorption**, but it is generally manageable and not considered a primary prognostic marker for disease aggressiveness itself. - While severe hypercalcemia can contribute to overall morbidity, its presence doesn't directly stage the disease or predict survival as significantly as B2 microglobulin. *Telomerase* - **Telomerase** is an enzyme involved in maintaining telomere length and is often overexpressed in various cancers, including MM, allowing cells to proliferate indefinitely. - While it plays a role in the **pathogenesis** of MM, its utility as a prognostic marker in routine clinical practice is not as established or as widely used as B2 microglobulin.

Q: All are increased in IDA except

Transferrin saturation. ***Transferrin saturation*** - In **iron deficiency anemia (IDA)**, there is insufficient iron to saturate transferrin, leading to a **decreased** transferrin saturation. This is the exception among the given options. - Transferrin saturation is calculated as (serum iron / TIBC) x 100, and both **serum iron** and its percentage saturation are low in IDA. *TIBC* - **Total iron-binding capacity (TIBC)** is typically **increased** in IDA as the liver produces more transferrin in an attempt to capture more iron [1]. - This elevated TIBC reflects the body's compensatory mechanism to maximize available iron uptake. *Soluble transferrin receptor* - **Soluble transferrin receptor (sTfR)** levels are **elevated** in IDA because iron-deficient erythroblasts upregulate the production of transferrin receptors on their surface as they try to scavenge more iron. - The elevated sTfR is a sensitive and specific marker for **iron deficiency**, particularly useful in differentiating IDA from anemia of chronic disease [1]. *Erythropoietin* - **Erythropoietin (EPO)** levels are **increased** in IDA due to the kidney's response to the decreased oxygen-carrying capacity of the blood (anemia) [1]. - EPO stimulates the bone marrow to produce more red blood cells, which exacerbates the demand for iron, often leading to further iron depletion if iron stores are low.

Question 1

Which of the following statements are correct regarding iron deficiency?

1. More common in older age group
2. More common in females of reproductive age
3. Associated with heavy menstrual bleeding
4. Commonly caused by chronic blood loss

Select the correct answer using the code given below.

Accepted Answer

1, 2 and 4

Answer

1, 2 and 3

Answer

2, 3 and 4

Answer

1, 3 and 4

Question 2

Which of the following statements are correct in respect of haemophilia?

1. It is hereditary bleeding disorder.
2. It has a higher incidence among Asians.
3. It affects females occasionally and mildly.

Accepted Answer

1 and 3 only

Answer

2 and 3 only

Answer

1 and 2 only

Answer

1, 2 and 3

Question 3

The following are the common features of Idiopathic Thrombocytopenic Purpura except

Accepted Answer

Massive splenomegaly

Answer

Cutaneous ecchymoses

Answer

Thrombocytopenia

Answer

Epistaxis

Question 4

Priapism in a young male could occur because of

Accepted Answer

leukaemia

Answer

carcinoid tumour of appendix

Answer

testicular cancer

Answer

penile cancer

Question 5

Umbilical cord blood stem cells are used to treat all the following diseases except :

Accepted Answer

Parkinsonism

Answer

Leukemia

Answer

Osteoporosis

Answer

Diabetes

Question 6

A patient has recurrent abdominal pain and jaundice. The blood investigations reveal reticulocytosis and hyperbilirubinemia. What is the clinical diagnosis?

Accepted Answer

Hereditary spherocytosis

Answer

Mirizzi's syndrome

Answer

Sclerosing cholangitis

Answer

Choledochal cyst

Question 7

Which of the following statements is correct about Paroxysmal Nocturnal Hemoglobinuria (PNH)?

Accepted Answer

Flow cytometry is the best investigation

Answer

Sucrose lysis test is used for the confirmation

Answer

The most common cause of death is heart failure

Answer

It is an inherited disorder

Question 8

An 18-year-old male presents to the OPD with gum bleeding, fever, low total leukocyte count (TLC), and low platelet count. General examination is unremarkable. Further investigations reveal a low reticulocyte count, absent megakaryocytes, and no immature cells in the bone marrow. What is the most likely diagnosis?

Accepted Answer

Aplastic anemia

Answer

Immune Thrombocytopenic Purpura (ITP)

Answer

Myelodysplastic Syndrome (MDS)

Answer

Acute Myeloid Leukemia (AML)

Question 9

Which of the following is considered a poor prognostic marker in multiple myeloma (MM)?

Accepted Answer

B2 microglobulins

Answer

Serum Creatinine

Answer

Hypercalcemia

Answer

Telomerase

Question 10

All are increased in IDA except

Accepted Answer

Transferrin saturation

Answer

TIBC

Answer

Soluble transferrin receptor

Answer

Erythropoietin

Hematology — MCQs

Hematology — MCQs

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