Hematology Practice Questions

Q: The following is not true of platelet transfusion -

Effective for 9-10 days. ***Effective for 9-10 days*** - Platelets have a normal lifespan of about 7-10 days in the circulation, but **transfused platelets** are effective for a much shorter duration, typically **3-4 days** at most. - This short post-transfusion lifespan is due to various factors including immediate consumption, destruction, and removal from the circulation. *Used in DIC* - Platelet transfusions are often indicated in **Disseminated Intravascular Coagulation (DIC)**, especially if there is significant bleeding and a platelet count below 50,000/microL [1]. - DIC involves widespread activation of the coagulation cascade, leading to the consumption of platelets and clotting factors, resulting in both **thrombosis** and **hemorrhage** [1]. *Useful in ITP* - Transfusions are generally **not useful in Immune Thrombocytopenic Purpura (ITP)**, except in severe, life-threatening hemorrhage. - In ITP, platelets are rapidly destroyed by **autoantibodies**, so transfused platelets would also be quickly destroyed, providing only a transient, minimal benefit. *Effects decrease with repeated usage* - With repeated transfusions, patients can develop **alloimmunization** to HLA antigens on donor platelets, leading to refractoriness. - This means subsequent transfusions may have a **diminished or no therapeutic effect**, as the immune system rapidly destroys the transfused platelets.

Q: A patient presents with pain in back. Lab investigation shows elevated ESR. X-ray skull shows multiple punched out lytic lesions. Most important investigation to be done is:

Serum electrophoresis. ***Serum electrophoresis*** - Elevated **ESR** coupled with **punched-out lytic lesions** on skull X-ray is highly suggestive of **multiple myeloma** [1]. - **Serum electrophoresis** is the most important investigation to confirm this by detecting a **monoclonal protein (M-spike)**, which is characteristic of the disease [1]. *Whole body scan* - While a **whole body scan** (like a bone scan or PET scan) can assess the extent of bone involvement, it is not the primary diagnostic test for multiple myeloma itself [1]. - The initial step after suspecting multiple myeloma is to confirm the presence of the **monoclonal gammopathy** [1]. *Serum acid phosphatase* - **Serum acid phosphatase** is more commonly associated with **prostate cancer**, especially its bone metastases. - It is not a primary diagnostic marker for multiple myeloma with the presented symptoms. *CT head with contrast* - A **CT head with contrast** would be useful for brain lesions or other intracranial pathologies directly, but the **punched-out lesions** seen on X-ray are indicative of bone marrow involvement rather than brain tissue. - It would not provide the specific diagnostic information for **multiple myeloma** that serum electrophoresis does.

Q: 65-year-old man presents with anemia, posterior column dysfunction, and plantar extensor. Which of the following is the likely cause

Vitamin B 12 deficiency. ***Vitamin B12 deficiency*** - **Vitamin B12 deficiency** commonly presents with a triad of symptoms, including **anemia** (megaloblastic), **neurological dysfunction** (posterior column dysfunction leading to impaired proprioception and vibratory sense), and in severe cases, abnormal reflexes like a **plantar extensor response** (Babinski sign) due to demyelination of the corticospinal tracts [1]. - The combination of **anemia** and specific neurological deficits, especially involving the **posterior columns** and motor pathways, is highly characteristic of this deficiency [1]. *Friedreich's ataxia* - This is a **hereditary neurodegenerative disorder** primarily affecting the **spinal cord** (dorsal columns, spinocerebellar tracts, corticospinal tracts) and cerebellum [2]. - While it causes **ataxia** and neurological symptoms, it typically does not present with **anemia** as a primary feature. *Tabes dorsalis* - **Tabes dorsalis** is a late neurological manifestation of **syphilis**, characterized by degeneration of the **posterior columns** of the spinal cord. - While it causes **posterior column dysfunction**, it is not typically associated with **anemia**; its characteristic symptoms include lancinating pains, Argyll Robertson pupils, and sensory ataxia. *Vitamin B1 deficiency* - **Vitamin B1 (thiamine) deficiency** can lead to conditions like **beriberi**, affecting cardiovascular, neurological, and gastrointestinal systems. - Neurological manifestations primarily involve peripheral neuropathy and Wernicke-Korsakoff syndrome, but **anemia** and specific **posterior column dysfunction** in the manner described are not typical features.

Q: Hand-foot syndrome is seen in ?

Sickle cell disease. Hand-foot syndrome is seen in ? ***Sickle cell disease*** - **Hand-foot syndrome (dactylitis)** is an early manifestation of sickle cell disease, particularly in infants and young children [2]. - It results from **vaso-occlusion** in the small blood vessels of the hands and feet, leading to painful swelling [3]. *Raynaud's phenomenon* - Characterized by episodes of **vasospasm** in the fingers and toes, causing color changes (white, blue, red) due to cold exposure or stress. - It does not involve the continuous, painful swelling seen in dactylitis. *Thalassemia* - A group of **inherited blood disorders** characterized by abnormal hemoglobin production, leading to anemia [3]. - While it can cause various bone changes due to marrow expansion, hand-foot syndrome (dactylitis) is not a typical presentation. *Frostbite* - This is an injury caused by tissue freezing due to prolonged exposure to **extremely cold temperatures** [1]. - It can lead to numbness, blistering, and tissue damage, but it is distinct from the vaso-occlusive crisis of hand-foot syndrome [1].

Q: One unit of fresh blood rises the Hb% concentration by:

1 gm%. **_1 gm%_** - Each unit of **packed red blood cells (PRBCs)** is expected to increase the recipient's hemoglobin by approximately **1 g/dL** (or 1 gm%). - This is a general guideline used in clinical practice for estimating the effectiveness of **blood transfusions**. _2.2 gm%_ - A rise of **2.2 gm%** is significantly higher than the expected increase from a single unit of PRBCs. - Such a substantial increase might suggest multiple units transfused or an unusual patient response. _0.1 gm%_ - A rise of only **0.1 gm%** is too low and would generally indicate either no significant effect from the transfusion or a rapid loss of the transfused blood. - This small increase is not consistent with the expected therapeutic effect of a **single unit of PRBCs**. _2gm%_ - While a **2 gm%** rise could be seen after two units of PRBCs, it is not the expected increase for a **single unit**. - The standard expectation for a single unit of PRBCs is approximately **1 gm%** increase in hemoglobin.

Q: Indications for FFP include

All of the options. ***All of the options*** - **Fresh frozen plasma (FFP)** is a versatile blood product with several key indications, including supplying deficient plasma proteins, rapidly reversing warfarin effects, and treating thrombotic thrombocytopenic purpura (TTP). [1] - Its broad utility stems from its content of **all coagulation factors**, naturally occurring anticoagulants, and plasma proteins. *Supplying deficient plasma proteins* - FFP is a good source of various **plasma proteins**, which can be deficient in certain conditions, though specific protein concentrates are often preferred if available. [1] - This use is considered when there are specific protein deficiencies leading to clinical symptoms, where replacement is necessary. *Rapid reversal of (effects of) warfarin* - FFP contains **all vitamin K-dependent coagulation factors** (II, VII, IX, X) that are inhibited by warfarin, making it effective for rapid reversal, especially in cases of active bleeding or urgent surgery. - However, **4-factor prothrombin complex concentrates (PCCs)** are often preferred for more rapid and concentrated factor replacement in this scenario due to their lower volume and faster administration. *Treatment of TTP* - **Thrombotic thrombocytopenic purpura (TTP)** is characterized by a deficiency of **ADAMTS13**, an enzyme that cleaves von Willebrand factor (vWF). FFP replacement provides this deficient enzyme. - **Plasma exchange**, which involves removing the patient's plasma and replacing it with FFP, is the cornerstone of TTP treatment.

Q: An asymptomatic patient on regular health checkup has platelet counts of 8,00,000/cu.mm. Next line of management is:

Follow up and observe. ***Follow up and observe*** - This patient is **asymptomatic** despite a high platelet count (800,000/cu.mm), suggesting that the thrombocytosis may be **benign** or a **transient phenomenon**. - In an asymptomatic patient with isolated thrombocytosis, it is crucial to **repeat the complete blood count (CBC)** to rule out laboratory error or a temporary reactive process before proceeding with invasive or extensive investigations. *Phlebotomy* - **Phlebotomy** is primarily used to reduce red cell mass in conditions like **polycythemia vera**, not typically for high platelet counts. - While it can be considered in specific cases of **thrombocytosis with erythrocytosis**, it is not the initial management for isolated asymptomatic thrombocytosis. *Plasmapheresis* - **Plasmapheresis** involves removing plasma and is indicated for conditions like thrombotic thrombocytopenic purpura (TTP) or some autoimmune diseases [2]. - It is **not used to manage isolated thrombocytosis**, as it does not directly affect platelet production or removal in a sustained manner. *Bone marrow biopsy* - A **bone marrow biopsy** is an invasive procedure generally reserved for investigating suspected **myeloproliferative neoplasms (MPN)** or other hematological malignancies [1]. - In an **asymptomatic patient** with an initial high platelet count, it is premature and not the first line of management without prior re-evaluation of the platelet count and exclusion of reactive causes [1].

Q: All are predisposing factors of Deep Vein thrombosis, EXCEPT :

Subungual melanoma. ***Subungual melanoma*** - This is a rare form of melanoma that develops under the nail, and while serious, it is **not a recognized predisposing factor for deep vein thrombosis (DVT)**. Its primary concerns are local invasion and metastasis. - Unlike conditions affecting blood clotting or endothelium, **subungual melanoma does not directly promote hypercoagulability, venous stasis, or endothelial damage** that contribute to DVT. *Lower limb trauma* - **Trauma to the lower limb** can cause **endothelial damage** to blood vessels and **venous stasis** due to immobility or swelling, both key components of **Virchow's triad** for DVT [1]. - **Fractures or severe soft tissue injuries** often necessitate immobilization and can lead to inflammation, further increasing the risk of clot formation [1]. *Cushing's syndrome* - **Cushing's syndrome** is associated with **hypercoagulability** due to increased levels of clotting factors, such as **factor VIII** and **fibrinogen**, and decreased fibrinolytic activity. - The **elevated cortisol levels** seen in Cushing's syndrome [2] can directly contribute to a prothrombotic state, significantly increasing DVT risk. *Hip surgery* - **Major orthopedic surgeries**, especially hip surgery [1], are well-known to cause significant **venous stasis** and **endothelial damage**. - **Post-operative immobility** and a generalized **inflammatory response** following surgery contribute to a high risk of DVT formation [1].

Q: Which of the following is most Likely to be fatal?

Multiple myeloma. No changes made because no provided references reached the relevance threshold of 7. The provided text fragments discuss coagulation factor deficiency (Waldenström macroglobulinemia), physiology of taste, and Lambert-Eaton Myasthenic Syndrome, which do not directly support the clinical descriptions of Multiple Myeloma, Osteochondroma, Paget's disease, or Giant Cell Tumour as presented in the explanation.

Q: Most common cause of iron deficiency in elderly

Gastric bleeding/ hemorrhage. ***Gastric bleeding/ hemorrhage*** - In elderly patients, **chronic blood loss** from the gastrointestinal (GI) tract due to conditions like **peptic ulcers**, **gastritis**, or **GI malignancies** is the most common cause of iron deficiency [1], [3]. - This **slow, insidious blood loss** often goes unnoticed until significant iron stores are depleted, leading to anemia [1]. *Decreased absorption of iron* - While iron absorption can be reduced in the elderly due to conditions like **atrophic gastritis** or certain medications, it is less common than blood loss as a primary cause in symptomatic iron deficiency [1]. - Impaired absorption usually contributes to iron deficiency but is rarely the **sole and most significant cause** compared to chronic GI bleeding. *Achlorhydria* - **Achlorhydria**, or reduced gastric acid production, can impair the conversion of ferric iron (Fe3+) toferrous iron (Fe2+), which is more readily absorbed. - This condition is common in the elderly and can contribute to iron malabsorption but is generally not the **leading cause of significant iron deficiency** in this population without underlying blood loss [3]. *Nutritional deficiency* - While elderly individuals may have **poor dietary intake** and therefore decreased iron intake, it is typically less common than chronic blood loss as the primary cause of iron deficiency in resource-rich settings [2]. - Significant iron deficiency due solely to diet usually requires extremely **restricted diets** or severe malnutrition, which is not the most prevalent reason in general elderly populations presenting with iron deficiency.

Question 1

The following is not true of platelet transfusion -

Accepted Answer

Effective for 9-10 days

Answer

Used in DIC

Answer

Useful in ITP

Answer

Effects decrease with repeated usage

Question 2

A patient presents with pain in back. Lab investigation shows elevated ESR. X-ray skull shows multiple punched out lytic lesions. Most important investigation to be done is:

Accepted Answer

Serum electrophoresis

Answer

Whole body scan

Answer

Serum acid phosphatase

Answer

CT head with contrast

Question 3

65-year-old man presents with anemia, posterior column dysfunction, and plantar extensor. Which of the following is the likely cause

Accepted Answer

Vitamin B 12 deficiency

Answer

Friedreich's ataxia

Answer

Tabes dorsalis

Answer

Vitamin B1 deficiency

Question 4

Hand-foot syndrome is seen in ?

Accepted Answer

Sickle cell disease

Answer

Raynaud's phenomenon

Answer

Thalassemia

Answer

Frost bite

Question 5

One unit of fresh blood rises the Hb% concentration by:

Accepted Answer

1 gm%

Answer

2.2 gm%

Answer

0.1 gm%

Answer

2gm%

Question 6

Indications for FFP include

Accepted Answer

All of the options

Answer

Supplying deficient plasma proteins

Answer

Rapid reversal of (effects of) warfarin

Answer

Treatment of TTP

Question 7

An asymptomatic patient on regular health checkup has platelet counts of 8,00,000/cu.mm. Next line of management is:

Accepted Answer

Follow up and observe

Answer

Phlebotomy

Answer

Plasmapheresis

Answer

Bone marrow biopsy

Question 8

All are predisposing factors of Deep Vein thrombosis, EXCEPT :

Accepted Answer

Subungual melanoma

Answer

Lower limb trauma

Answer

Cushing's syndrome

Answer

Hip surgery

Question 9

Which of the following is most Likely to be fatal?

Accepted Answer

Multiple myeloma

Answer

Osteochondroma

Answer

Paget's disease

Answer

Giant cell tumour

Question 10

Most common cause of iron deficiency in elderly

Accepted Answer

Gastric bleeding/ hemorrhage

Answer

Decreased absorption of iron

Answer

Achlorhydria

Answer

Nutritional deficiency

Hematology — MCQs

Hematology — MCQs

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