Hematopathology Practice Questions

Q: Which of the following is not associated with the disorder characterized by findings on a peripheral blood smear?

Predisposition to malaria. ***Predisposition to malaria*** - Sickle cell disease/trait actually provides **protection against malaria**, not predisposition, due to the **hostile environment** for Plasmodium parasites in sickled red blood cells. - This protective effect is an evolutionary advantage in **malaria-endemic regions**, explaining the high prevalence of sickle cell trait in these areas. *Hand-foot syndrome* - Also known as **dactylitis**, this is a common complication of sickle cell disease caused by **vaso-occlusive crises** in small bones. - Results in painful swelling of hands and feet, particularly common in **infants and young children** with sickle cell disease. *Acute chest syndrome* - A serious complication of sickle cell disease involving **pulmonary vaso-occlusion**, infection, or fat embolism. - Presents with chest pain, fever, and **pulmonary infiltrates** on chest X-ray, requiring immediate medical attention. *Predisposition to Salmonella osteomyelitis* - Occurs due to **functional asplenia** from repeated splenic infarctions in sickle cell disease patients. - **Salmonella** species have particular tropism for infarcted bone tissue, making osteomyelitis more common than **Staphylococcus aureus** in these patients.

Q: Stored blood, which has been preserved in a blood bank, is deficient in which of the following coagulation factors?

V and VIII. **Explanation:** The correct answer is **V and VIII** because these are known as **labile coagulation factors**. In blood bank storage (typically at 1–6°C in CPDA-1), the activity of most coagulation factors remains relatively stable. However, Factors V and VIII are highly sensitive to temperature and storage time. Their activity begins to decline significantly within 24–48 hours of collection. By the time a unit of whole blood reaches its expiration (35–42 days), these factors are virtually absent. This is why patients requiring these specific factors (e.g., in Hemophilia A or massive transfusion) require **Fresh Frozen Plasma (FFP)** or **Cryoprecipitate**, where these factors are preserved by rapid freezing. **Analysis of Incorrect Options:** * **Option A & B (II and VII):** Factor II (Prothrombin) and Factor VII are **stable factors** [1]. They maintain adequate activity levels throughout the shelf-life of stored blood. * **Option D (IX and X):** These are also stable factors. Along with Factors II and VII, they are Vitamin K-dependent and do not degrade significantly during standard refrigerated storage [2]. **NEET-PG High-Yield Pearls:** 1. **Massive Transfusion Complication:** Transfusing large volumes of stored blood (which lacks V and VIII) can lead to **dilutional coagulopathy**. 2. **Storage Lesion:** This term refers to the biochemical and morphological changes in stored blood, including decreased 2,3-DPG (shifting the oxygen dissociation curve to the left), decreased pH, and increased potassium. 3. **Factor VIII Source:** Cryoprecipitate is the richest source of Factor VIII, Fibrinogen, and von Willebrand Factor (vWF). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 582-583. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 624-625.

Q: Macrocytic anemia is not seen in which of the following conditions?

Anemia of chronic disease. The classification of anemia is primarily based on the **Mean Corpuscular Volume (MCV)**. Macrocytic anemia is defined by an MCV >100 fL. **Why Anemia of Chronic Disease (ACD) is the correct answer:** ACD is typically a **normocytic, normochromic anemia**. In long-standing cases, it may progress to a **microcytic** pattern, but it is **never macrocytic** [2]. The pathophysiology involves high levels of **Hepcidin** (induced by IL-6), which sequesters iron in macrophages and decreases intestinal iron absorption, mimicking a functional iron deficiency [1]. **Why the other options are incorrect:** * **Vitamin B12 deficiency:** This is a classic cause of **megaloblastic macrocytic anemia** [1]. Lack of B12 impairs DNA synthesis, leading to nuclear-cytoplasmic asynchrony where the nucleus matures slower than the cytoplasm, resulting in large cells. * **Hemolytic Anemia & Post-hemorrhagic Anemia:** Both conditions trigger a robust bone marrow response, leading to **reticulocytosis** (increased young RBCs). Since reticulocytes are larger than mature erythrocytes, a high reticulocyte count falsely elevates the MCV, causing a **non-megaloblastic macrocytic** picture. **High-Yield Clinical Pearls for NEET-PG:** * **Megaloblastic Macrocytosis:** Characterized by hypersegmented neutrophils (≥5 lobes) on peripheral smear. Causes: B12/Folate deficiency, Drugs (Methotrexate, Phenytoin, Zidovudine). * **Non-megaloblastic Macrocytosis:** No hypersegmented neutrophils. Causes: Alcoholism (most common), Liver disease, Hypothyroidism, and Reticulocytosis. * **ACD Hallmark:** Low Serum Iron, **Low TIBC**, and **High/Normal Ferritin** (distinguishes it from Iron Deficiency Anemia where Ferritin is low).

Q: Hemolytic disease of the newborn is commonly due to incompatibility of which antigen?

D antigen in the Rh group. **Explanation:** **Hemolytic Disease of the Newborn (HDN)**, also known as erythroblastosis fetalis, occurs when maternal antibodies cross the placenta and destroy fetal red blood cells. This happens when the mother is sensitized to a fetal blood group antigen that she lacks. **Why Option B is Correct:** The **D antigen** of the Rh blood group system is the most potent immunogen among all human blood group antigens. Rh incompatibility typically occurs when an **Rh-negative mother (d/d)** carries an **Rh-positive fetus (D/d)**. If fetal D-positive cells enter the maternal circulation (usually during delivery), the mother produces anti-D IgG antibodies. In subsequent pregnancies, these IgG antibodies cross the placenta, leading to hemolysis. Despite the use of Rh immunoglobulin (Anti-D prophylaxis), it remains the most common cause of severe HDN. **Why Other Options are Incorrect:** * **Options A & C (C and E antigens):** While other Rh antigens like C, c, E, and e can cause HDN, they are significantly less immunogenic than the D antigen and are rare causes of clinical disease. * **Option D (Lewis antigen):** Lewis antigens (Le^a, Le^b) are not implicated in HDN because they are primarily IgM (which does not cross the placenta) and are not well-developed on fetal red cells at birth. **NEET-PG High-Yield Pearls:** * **Most Common Cause of HDN overall:** ABO incompatibility (usually Mother 'O' and Baby 'A' or 'B'). It is often milder and can occur in the first pregnancy. * **Most Common Cause of SEVERE HDN:** Rh (D) incompatibility. * **Standard Prophylaxis:** 300 mcg of Anti-D is given to Rh-negative mothers at 28 weeks gestation and within 72 hours of delivery of an Rh-positive infant. * **Kleihauer-Betke Test:** Used to quantify the amount of fetal-maternal hemorrhage to determine the required dose of Anti-D.

Question 1

Which virus is most commonly associated with Burkitt's lymphoma?

Accepted Answer

Epstein-Barr virus (EBV)

Answer

Human Herpesvirus (HHV)

Answer

Human Immunodeficiency Virus (HIV)

Answer

Human T-lymphotropic virus (HTLV)

Question 2

Which of the following can cause eosinophilia?

Accepted Answer

Miliary tuberculosis

Answer

Hodgkin's disease

Answer

Filariasis

Answer

HIV infection

Question 3

What is the most common mutation in hemophilia?

Accepted Answer

Intron 22 inversion

Answer

Intron 1 inversion

Answer

619 bp deletion

Answer

3.7 kb deletion

Question 4

A blood smear is best visualized at which pH?

Accepted Answer

6.8

Answer

7.2

Answer

6.6

Answer

7

Question 5

Which of the following is not associated with the disorder characterized by findings on a peripheral blood smear?

Accepted Answer

Predisposition to malaria

Answer

Hand-foot syndrome

Answer

Acute chest syndrome

Answer

Predisposition to Salmonella osteomyelitis

Question 6

Estimation of the degradation products of the cross-linked fibrin fibers in DIC can best, specifically, and accurately be done by which of the following tests?

Accepted Answer

D-dimer assay

Answer

Fibrinopeptide assay

Answer

Euglobin lysis test

Answer

Coombs test

Question 7

Which of the following statements regarding megaloblastic anemia is true?

Accepted Answer

Serum lactate dehydrogenase (LDH) is increased.

Answer

Megaloblastic precursors are present in the bone marrow.

Answer

Mean corpuscular volume is increased.

Answer

Thrombocytosis occurs.

Question 8

Stored blood, which has been preserved in a blood bank, is deficient in which of the following coagulation factors?

Accepted Answer

V and VIII

Answer

II only

Answer

II and VII

Answer

IX and X

Question 9

Macrocytic anemia is not seen in which of the following conditions?

Accepted Answer

Anemia of chronic disease

Answer

Vitamin B12 deficiency

Answer

Hemolytic anemia

Answer

Post-hemorrhagic anemia

Question 10

Hemolytic disease of the newborn is commonly due to incompatibility of which antigen?

Accepted Answer

D antigen in the Rh group

Answer

C antigen in the Rh group

Answer

E antigen in the Rh group

Answer

Lewis antigen

Hematopathology — MCQs

Hematopathology — MCQs

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