Hematology Practice Questions

Q: Complication of blood transfusion can be all except -

Metabolic alkalosis. ***Metabolic alkalosis*** - **Metabolic alkalosis** is generally not a direct complication of blood transfusion, as transfused blood typically has a buffering effect or contributes to acidosis due to stored products. - While citrate, a component of transfused blood, is metabolized to bicarbonate, leading to a theoretical alkalosis, clinically significant metabolic alkalosis is rare and overshadowed by other potential imbalances. *Hyperkalemia* - **Hyperkalemia** can occur, especially with massive transfusions or in patients with impaired renal function, due to the leakage of potassium from red blood cells during storage. - The breakdown of stored red blood cells releases intracellular potassium into the plasma of the stored blood product. *Citrate toxicity* - **Citrate toxicity** is a known complication, particularly with rapid or massive transfusions, as citrate in stored blood binds to calcium, leading to hypocalcemia. - This can result in symptoms such as paresthesias, tetany, and cardiac arrhythmias if not managed appropriately. *Hypothermia* - **Hypothermia** is a common complication, especially with rapid or massive transfusions of refrigerated blood products. - Administering large volumes of cold intravenous fluids can significantly lower the patient's core body temperature.

Q: Treatment of choice in intracranial ALL is:

Intrathecal methotrexate. ***Intrathecal methotrexate*** - **Intrathecal methotrexate** is the cornerstone of central nervous system (CNS) prophylaxis and treatment for **intracranial acute lymphoblastic leukemia (ALL)** due to its ability to reach high concentrations in the cerebrospinal fluid (CSF). - It is highly effective in eradicating leukemic cells in the **CNS**, preventing leptomeningeal relapse, and is often combined with other intrathecal agents or cranial radiation. *Intrathecal vincristine* - **Vincristine** is primarily an intravenous chemotherapeutic agent and is **neurotoxic** when administered intrathecally, potentially causing severe and irreversible neurological damage, including paralysis and death. - Therefore, **intrathecal vincristine** is contraindicated due to its severe adverse effects on the CNS. *Vincristine and prednisolone* - **Vincristine** and **prednisolone** are systemic agents typically administered intravenously and orally, respectively, and are crucial components of **induction and consolidation therapy** for ALL. - However, their ability to penetrate the **blood-brain barrier** is limited, making them ineffective for directly treating or preventing intracranial ALL. *Prednisolone* - **Prednisolone** is a corticosteroid used systemically for its **anti-inflammatory** and **cytotoxic effects** on leukemic cells, particularly in inducing remission in ALL. - While it can partially penetrate the **blood-brain barrier**, its concentration in the CSF is usually insufficient to effectively treat or prevent established **intracranial ALL** on its own.

Q: The following condition is not associated with an Anti-phospholipid syndrome -

Thrombocytosis. ***Thrombocytosis*** - **Antiphospholipid syndrome (APS)** is characterized by a **prothrombotic state**, leading to **thrombocytopenia** (low platelet count), not thrombocytosis (elevated platelet count) [1]. - Elevated platelet counts are not part of the diagnostic criteria or typical clinical manifestations of APS. *Neurological manifestations* - **Neurological symptoms** are common in APS and can include **stroke**, **transient ischemic attacks (TIAs)**, **seizures**, and **cognitive dysfunction**. - These manifestations are due to the prothrombotic tendency affecting the cerebral vasculature. *Venous thrombosis* - **Venous thrombosis**, particularly **deep vein thrombosis (DVT)** and **pulmonary embolism (PE)**, is a hallmark feature of APS [2]. - The presence of antiphospholipid antibodies promotes clot formation in both venous and arterial systems. *Recurrent foetal loss* - **Recurrent foetal loss** (miscarriages or stillbirths) is a classic obstetric manifestation of APS [1]. - This occurs due to thrombosis in the placental circulation, impairing fetal development and viability [2].

Q: False about Marble bone disease

Associated with Type II Renal Tubular Acidosis. ***Associated with Type II Renal Tubular Acidosis*** - **Marble bone disease**, or **osteopetrosis**, is characterized by increased bone density due to defective osteoclast function [1]. - It is **not typically associated** with Type II Renal Tubular Acidosis; instead, some forms of osteopetrosis, particularly carbonic anhydrase II deficiency, can lead to **Type I (distal) Renal Tubular Acidosis** [1]. *Pancytopenia* - **Osteopetrosis** leads to bone marrow encroachment, reducing the space available for hematopoiesis. - This often results in **pancytopenia** (anemia, leukopenia, and thrombocytopenia) due to bone marrow failure. *Treated with bone marrow transplantation* - **Bone marrow transplantation (BMT)** is a crucial treatment for severe forms of osteopetrosis, especially the infantile malignant autosomal recessive type. - BMT can introduce functional **osteoclast precursors** from the donor, which can then differentiate and restore bone resorption. *Mandible osteomyelitis* - Patients with **osteopetrosis** have bones that are dense but paradoxically brittle, making them prone to fractures and infections. - The **mandible** is particularly susceptible to **osteomyelitis** due to its dense structure and vascular compromise in osteopetrosis, often complicated by dental issues.

Q: Which of the following is false regarding transfusion-associated anaphylactic reactions?

Seen in IgG deficient individuals. ***Seen in IgG deficient individuals*** - Transfusion-associated **anaphylactic reactions** are most commonly seen in **IgA-deficient individuals** who develop **anti-IgA antibodies** and receive blood products containing IgA. - Anaphylaxis occurs when these pre-formed IgA antibodies react with donor IgA, leading to mast cell degranulation and severe allergic symptoms. *Different from allergy* - Transfusion-associated **anaphylactic reactions** are a severe form of allergic reaction, often distinguished by their **rapid onset** and life-threatening nature [1]. - While all allergies involve an immune response to an allergen, anaphylaxis represents the most extreme systemic manifestation. *Epinephrine is the drug of choice* - **Epinephrine** is indeed the **first-line treatment** for acute anaphylaxis, regardless of its cause, including transfusion-associated reactions [2]. - It acts rapidly to counteract the systemic effects of histamine and other mediators by acting on α and β adrenergic receptors [3]. *Washed blood products prevent it* - **Washing blood products** (e.g., packed red blood cells or platelets) is an effective strategy to **remove plasma proteins**, including IgA. - This is particularly crucial for patients with a known **IgA deficiency and anti-IgA antibodies** to prevent severe anaphylactic reactions.

Q: A patient presents with MCV = 60, Hb = 5 gm%, MCHC = 20 & PCV = 32%. What is the MOST COMMON cause of this type of anemia in developing countries?

C) Hookworm infection. ***Hookworm infection*** - The presented lab values (MCV = 60, Hb = 5 gm%, MCHC = 20) indicate severe **microcytic hypochromic anemia**, which is a classic presentation of **iron deficiency anemia** [1], [2]. - In developing countries, **chronic blood loss** due to **hookworm infection** is the most common cause of sustained iron deficiency, leading to this type of anemia [2], [3]. *Phenytoin* - **Phenytoin** is an anticonvulsant that can cause **megaloblastic anemia** due to **folate deficiency**, not microcytic hypochromic anemia. - Its effects on red blood cells typically result in an **increased MCV**, not a decreased one. *Blind loop syndrome* - **Blind loop syndrome** leads to bacterial overgrowth in the small intestine, which can cause **vitamin B12 deficiency** due to bacterial consumption of B12. - This deficiency results in **megaloblastic anemia** (high MCV), not microcytic hypochromic anemia. *Chronic kidney disease with normal iron studies* - **Chronic kidney disease** primarily causes **normocytic normochromic anemia** due to decreased erythropoietin production [4]. - While it causes anemia, the red blood cell indices (MCV, MCHC) would typically be within the normal range, unlike the **microcytic hypochromic** values observed here.

Q: A 20-year-old woman with a family history of von Willebrand disease is found to have an activated partial thromboplastin time (aPTT) of 78 (normal = 32) on routine testing prior to cholecystectomy. Further investigation reveals a prothrombin time (PT) of 13 (normal = 12), a platelet count of 350,000/mm³, and an abnormal bleeding time. Which of the following should be administered in the perioperative period?

Desmopressin (DDAVP). ***Desmopressin (DDAVP)*** - **Desmopressin** is the first-line treatment for **von Willebrand disease (vWD)** [1], especially for type 1, which this patient's profile suggests (prolonged aPTT, normal PT, normal platelet count, and abnormal bleeding time). - It works by stimulating the release of endogenous **von Willebrand factor (vWF)** and **factor VIII** from endothelial cells [1]. *Factor VIII* - While Factor VIII deficiency can cause prolonged aPTT, this patient's presentation with a family history of **vWD**, normal PT, and abnormal bleeding time points specifically to a **vWF** defect rather than isolated **Factor VIII** deficiency [1]. - Administration of direct **Factor VIII** is not the primary treatment for **vWD**, although vWF concentrate (which contains Factor VIII) may be used for severe cases [1]. *Platelets* - The patient's **platelet count is normal** (350,000/mm³), indicating that a platelet transfusion is not necessary. - **vWD** is a disorder of platelet adhesion, not a problem with platelet quantity. *Vitamin K* - **Vitamin K** is essential for the synthesis of coagulation factors II, VII, IX, and X, as well as proteins C and S. - A deficiency in **Vitamin K** typically results in a prolonged **PT** [2], which is normal in this patient.

Q: Which of these is not a risk factor for thromboembolism -

Regular exercise. ***Regular exercise*** - **Regular exercise** is a protective factor against thromboembolism, as it improves blood circulation and reduces venous stasis. - It also helps maintain a healthy weight and cardiovascular fitness, lowering overall risk. *Superficial thrombophlebitis* - While typically less serious than deep vein thrombosis (DVT), **superficial thrombophlebitis** can extend into deeper veins or serve as a risk marker for DVT. - Inflammation and clot formation in superficial veins can sometimes trigger or coexist with more significant thromboembolic events [1]. *Myocardial infarction* - A **myocardial infarction** increases the risk for thromboembolism due to cardiac wall motion abnormalities and subsequent eddy currents causing thrombus formation within the ventricle [2]. - The damaged heart muscle can also release pro-coagulant factors, further elevating the risk. *Estrogen therapy* - **Estrogen therapy**, particularly in higher doses or certain formulations, is known to increase the risk for venous and arterial thromboembolism. - This is due to stimulating the production of clotting factors and reducing the activity of natural anticoagulants.

Question 1

Complication of blood transfusion can be all except -

Accepted Answer

Metabolic alkalosis

Answer

Hyperkalemia

Answer

Citrate toxicity

Answer

Hypothermia

Question 2

Treatment of choice in intracranial ALL is:

Accepted Answer

Intrathecal methotrexate

Answer

Intrathecal vincristine

Answer

Vincristine and prednisolone

Answer

Prednisolone

Question 3

The following condition is not associated with an Anti-phospholipid syndrome -

Accepted Answer

Thrombocytosis

Answer

Neurological manifestations

Answer

Venous thrombosis

Answer

Recurrent foetal loss

Question 4

False about Marble bone disease

Accepted Answer

Associated with Type II Renal Tubular Acidosis

Answer

Pancytopenia

Answer

Treated with bone marrow transplantation

Answer

Mandible osteomyelitis

Question 5

Splenectomy is least useful in

Accepted Answer

Hereditary nonspherocytic haemolytic anaemia

Answer

Congenital elliptocytosis

Answer

Thalassemia major

Answer

Congenital spherocytic anaemia

Question 6

Which of the following is false regarding transfusion-associated anaphylactic reactions?

Accepted Answer

Seen in IgG deficient individuals

Answer

Different from allergy

Answer

Epinephrine is the drug of choice

Answer

Washed blood products prevent it

Question 7

A patient presents with MCV = 60, Hb = 5 gm%, MCHC = 20 & PCV = 32%. What is the MOST COMMON cause of this type of anemia in developing countries?

Accepted Answer

C) Hookworm infection

Answer

A) Phenytoin

Answer

B) Blind loop syndrome

Answer

D) Chronic kidney disease with normal iron studies

Answer

Question 8

A 20-year-old woman with a family history of von Willebrand disease is found to have an activated partial thromboplastin time (aPTT) of 78 (normal = 32) on routine testing prior to cholecystectomy. Further investigation reveals a prothrombin time (PT) of 13 (normal = 12), a platelet count of 350,000/mm³, and an abnormal bleeding time. Which of the following should be administered in the perioperative period?

Accepted Answer

Desmopressin (DDAVP)

Answer

Factor VIII

Answer

Platelets

Answer

Vitamin K

Question 9

Which of these is not a risk factor for thromboembolism -

Accepted Answer

Regular exercise

Answer

Superficial thrombophlebitis

Answer

Myocardial infarction

Answer

Estrogen therapy

Question 10

All of the following statements about Lupus Anticoagulant are true, EXCEPT:

Accepted Answer

Thrombotic spells can be followed by severe life threatening hemorrhage

Answer

May present with Recurrent Abortions

Answer

May occur with minimal clinical manifestations

Answer

May present with an isolated prolongation of APTT

Hematology — MCQs

Hematology — MCQs

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