Hematopathology Practice Questions

Q: A peripheral blood smear is given, blasts count more than 60%. Immunophenotyping reveals positivity for CD13 and CD33. Negative CD19. What is the most likely diagnosis?

AML. ***AML*** - Myeloid lineage markers include **CD13** and **CD33**, which are hallmark immunophenotypic features of **Acute Myeloid Leukemia (AML)**. - A blast count greater than **20%** in the peripheral blood or bone marrow is diagnostic criteria for acute leukemia rather than a chronic process. *CML* - Typically characterized by **myeloid hyperplasia** with a full spectrum of myeloid production rather than a massive (>20%) blast crisis. - The presence of the **Philadelphia chromosome**, resulting in the **BCR-ABL1 fusion gene**, is the diagnostic driver for this condition. *ALL* - Typically positive for lymphoid markers like **CD19**, **CD10**, or **CD20** (B-cell lineage) or **CD3** (T-cell lineage). - The absence of lymphoid markers and presence of myeloid markers effectively rules out this acute leukemia subtype. *CLL* - A chronic condition characterized by the proliferation of **mature, small lymphocytes** with classic

Q: Which genetic abnormality is classically associated with Burkitt lymphoma?

t(8;14). ***t(8;14)*** - This translocation results in the **overexpression of the c-MYC oncogene** on chromosome 8 due to its placement next to the **immunoglobulin heavy chain (IgH) locus** on chromosome 14. - This specific genetic defect leads to high **cellular proliferation** rates, which is a hallmark of the diagnostically distinct **starry-sky appearance** seen in Burkitt lymphoma histology. *t(14;18)* - This translocation is characteristic of **follicular lymphoma**, resulting in the overexpression of the **BCL-2 anti-apoptotic protein**. - It prevents follicular center B-cells from undergoing apoptosis, leading to an expansion of these cells in the lymph nodes. *t(11;14)* - This translocation identifies **mantle cell lymphoma**, caused by the overexpression of **cyclin D1**. - Cyclin D1 promotes cell cycle progression from G1 to S phase, contributing to the aggressive growth of this subtype of non-Hodgkin lymphoma. *t(9;22)* - This is the famous **Philadelphia chromosome**, characterized by the formation of the **BCR-ABL fusion gene**. - It is the defining genetic abnormality in **chronic myeloid leukemia (CML)** and certain subsets of acute lymphoblastic leukemia (ALL).

Q: A peripheral blood smear is shown below. Which supravital stain was used?

New Methylene Blue. ***New Methylene Blue*** - This is a **supravital stain** used to visualize **reticulocytes** in peripheral blood by precipitating residual ribosomal RNA into distinct blue granules. - Unlike routine Romanowsky stains, it stains living red blood cells before fixation, allowing for an accurate identification of these immature cells to assess bone marrow output. *Giemsa stain* - This is a **Romanowsky stain** commonly used for identifying **malaria parasites** and other blood-borne pathogens. - It is a permanent fixative stain, not a **supravital stain**, and does not effectively visualize the ribosomal aggregates characteristic of reticulocytes. *Leishman stain* - Leishman stain is a standard **Romanowsky stain** used for routine differential counts of peripheral blood leucocytes. - It utilizes an alcohol-based fixative, prohibiting the observation of living cell processes, making it unsuitable for **supravital** staining purposes. *Diff-Quik stain* - This is a rapid, modified **Romanowsky stain** often used in cytology and hematology laboratories for quick assessment of cell morphology. - As a fixative-dependent stain, it lacks the specific chemical properties required to demonstrate **reticulocyte** RNA, which requires a vital dye.

Q: A patient diagnosed with beta-thalassemia major is being evaluated. Which of the following is characteristically associated with this condition?

Intravascular hemolysis. ***Intravascular hemolysis*** - In beta-thalassemia major, the accumulation of **unpaired alpha-globin chains** results in the formation of insoluble precipitates within red blood cell precursors. - This leads to **intramedullary hemolysis** and damage to the red cell membrane, which manifests as significant hemolysis, often both intramedullary and peripheral. *Iron overload* - While **iron overload** is a hallmark clinical complication of beta-thalassemia major, it is a **secondary phenomenon** resulting from repeated transfusions and increased intestinal absorption, rather than the primary hematologic mechanism. - It leads to **hemosiderosis** in organs like the liver, heart, and endocrine glands, but is distinct from the primary defect of effective erythropoiesis. *Leukopoiesis* - **Leukopoiesis** refers to the production of white blood cells and is not the primary process affected in beta-thalassemia major. - The bone marrow in this condition preferentially expands its **erythroid lineage** to compensate for anemia, rather than increasing leukopoiesis. *Ineffective hematopoiesis* - This refers to the **premature destruction of erythroid precursors** within the bone marrow, which is a key feature of the disease. - However, while **ineffective erythropoiesis** is a central component, the question specifically asks for a characteristic associated phenomenon; the **hemolysis** caused by globin chain imbalance is the fundamental driver of the hematologic phenotype.

Q: A patient presents with Hb 8 g/dL, MCV 62 fL, and low serum ferritin. Which type of anemia is most likely?

Iron deficiency anemia. ***Iron deficiency anemia*** - The combination of **microcytic anemia** (low MCV) and **low serum ferritin** is diagnostic for iron deficiency anemia, representing the body's depleted iron stores. - This is the most common cause of microcytic anemia, typically resulting from chronic blood loss, poor dietary intake, or malabsorption. *Sideroblastic anemia* - Characterized by inadequate utilization of iron for heme synthesis, usually leading to **high serum ferritin** and iron overload, rather than low, due to iron deposition in mitochondria. - Often shows **ringed sideroblasts** in the bone marrow, a classic feature that distinguishes it from iron deficiency. *Megaloblastic anemia* - Presents with **macrocytic anemia** (high MCV), not microcytic, due to impaired DNA synthesis (e.g., Vitamin B12 or folate deficiency). - The presence of **hypersegmented neutrophils** on a peripheral blood smear is a hallmark feature, which is not present in microcytic cases. *Aplastic anemia* - A **normocytic (or macrocytic)** anemia caused by bone marrow failure and pancytopenia, not typically microcytic. - Serum ferritin levels in aplastic anemia are usually **elevated** due to ineffective erythropoiesis and frequent blood transfusions.

Question 1

A peripheral blood smear is given, blasts count more than 60%. Immunophenotyping reveals positivity for CD13 and CD33. Negative CD19. What is the most likely diagnosis?

Accepted Answer

AML

Answer

CML

Answer

ALL

Answer

CLL

Question 2

Which genetic abnormality is classically associated with Burkitt lymphoma?

Accepted Answer

t(8;14)

Answer

t(14;18)

Answer

t(11;14)

Answer

t(9;22)

Question 3

A peripheral blood smear is shown below. Which supravital stain was used?

Accepted Answer

New Methylene Blue

Answer

Giemsa stain

Answer

Leishman stain

Answer

Diff-Quik stain

Question 4

A patient diagnosed with beta-thalassemia major is being evaluated. Which of the following is
characteristically associated with this condition?

Accepted Answer

Intravascular hemolysis

Answer

Iron overload

Answer

Leukopoiesis

Answer

Ineffective hematopoiesis

Question 5

A patient presents with Hb 8 g/dL, MCV 62 fL, and low serum ferritin. Which type of anemia is
most likely?

Accepted Answer

Iron deficiency anemia

Answer

Sideroblastic anemia

Answer

Megaloblastic anemia

Answer

Aplastic anemia

Hematopathology — MCQs

Hematopathology — MCQs

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