Hematopathology Practice Questions

Q: What is the most common cause of complications in blood transfusion?

Human error. **Explanation:** The most common cause of transfusion-related complications and fatalities is **Human Error**. Despite advanced screening for pathogens and immunological testing, clerical mistakes remain the leading risk factor. These errors typically occur during sample labeling, patient identification at the bedside, or issuing the wrong blood unit from the blood bank [1]. This leads to **ABO incompatibility**, which can trigger life-threatening acute hemolytic transfusion reactions (AHTR). **Analysis of Options:** * **Anaphylaxis (Option B):** While common among allergic reactions, it is far less frequent than clerical errors. It is usually caused by IgA deficiency in the recipient who has anti-IgA antibodies [1]. * **Graft-versus-host disease (Option C):** GVHD is a rare but highly fatal complication occurring in immunocompromised patients. It is prevented by gamma irradiation of blood products, not a "most common" occurrence. * **Presensitization (Option D):** This refers to the presence of pre-formed antibodies (from prior transfusions or pregnancies). While it causes delayed hemolytic reactions, modern cross-matching techniques have significantly reduced its incidence compared to human-led bedside errors. **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall reaction:** Febrile Non-Hemolytic Transfusion Reaction (FNHTR), caused by cytokines or HLA antibodies. * **Most common cause of transfusion-related death:** Historically ABO incompatibility (human error) [1], but in many modern registries, **TRALI** (Transfusion-Related Acute Lung Injury) is cited as the leading cause of mortality. * **Golden Rule:** Always perform a double-check of patient identity and blood bag labels at the bedside to prevent the most common cause of morbidity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 673-674.

Q: What is true about smoldering multiple myeloma?

Presence of monoclonal gammopathy. **Explanation:** Smoldering Multiple Myeloma (SMM) is an intermediate clinical stage between Monoclonal Gammopathy of Undetermined Significance (MGUS) and symptomatic Multiple Myeloma [1]. **1. Why Option A is Correct:** By definition, SMM requires the presence of a **monoclonal (M) protein** (serum IgG or IgA ≥30 g/L) or urinary monoclonal protein (≥500 mg/24h) [1]. It represents a clonal proliferation of plasma cells that produces a monoclonal gammopathy detectable on serum protein electrophoresis (SPEP), but without the immediate end-organ damage seen in active myeloma. **2. Why the Other Options are Incorrect:** * **Options B & C:** The hallmark of SMM is the **absence of CRAB features** (Calcium elevation, Renal insufficiency, Anemia, and Bone lesions) [1]. If lytic bone lesions or hypercalcemia are present, the diagnosis upgrades to symptomatic Multiple Myeloma. * **Option D:** In SMM, the bone marrow plasma cell (BMPC) percentage must be **between 10% and 60%** [1]. If the BMPC is 60%, it is classified as active Multiple Myeloma (even in the absence of CRAB features). **Clinical Pearls for NEET-PG:** * **Diagnostic Criteria for SMM:** Serum M-protein ≥30 g/L AND/OR BMPC 10–60% AND absence of myeloma-defining events (CRAB) [1]. * **Risk of Progression:** SMM has a much higher rate of progression to overt myeloma (approx. 10% per year) compared to MGUS (1% per year). * **High-Yield Distinction:** Remember that **MGUS** has M-protein <30 g/L and BMPC <10%, whereas **SMM** has higher values but remains asymptomatic [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 606-609.

Q: All are true about splenic marginal zone lymphoma, EXCEPT:

The clinical course is virulent.. **Splenic Marginal Zone Lymphoma (SMZL)** is a rare, low-grade B-cell neoplasm. Understanding its indolent nature is key to answering this question. ### **Explanation of the Correct Answer** **Option D is the correct answer (the false statement)** because SMZL typically follows an **indolent (slow-growing) clinical course**, not a virulent one. Most patients have a median survival exceeding 10 years. Treatment is often conservative ("watch and wait") or involves splenectomy/Rituximab, rather than aggressive chemotherapy. ### **Analysis of Incorrect Options** * **Option A:** Autoimmune manifestations are common in SMZL. Approximately 10–15% of patients present with **autoimmune hemolytic anemia (AIHA)** or **immune thrombocytopenia (ITP)**. * **Option B:** As the name implies, the tumor originates from the **marginal zone B-cells** of the splenic white pulp. These cells eventually infiltrate the red pulp and the peripheral blood. * **Option C:** While peripheral lymphadenopathy is rare in SMZL (a key diagnostic feature), **splenic hilar lymph nodes** are frequently involved as they are the primary drainage site for the spleen. ### **High-Yield NEET-PG Pearls** * **Clinical Presentation:** Massive splenomegaly is the hallmark. Peripheral lymphadenopathy is characteristically absent. * **Morphology:** Look for **"Villous lymphocytes"** (short, polar cytoplasmic projections) in the peripheral blood smear. * **Immunophenotype:** Typically **CD20+, CD5–, CD10–, CD23–, and CD103–**. This helps differentiate it from CLL (CD5+) and Hairy Cell Leukemia (CD103+). * **Association:** There is a strong clinical association with **Hepatitis C Virus (HCV)** infection; treating the virus can sometimes lead to lymphoma regression. * **Genetics:** Often associated with **7q31 deletion**.

Question 1

What is the most common cause of complications in blood transfusion?

Accepted Answer

Human error

Answer

Anaphylaxis

Answer

Graft-versus-host disease (GVHD)

Answer

Presensitization

Question 2

Both PT and APTT are prolonged in which of the following conditions?

Accepted Answer

Factor II Deficiency

Answer

Thrombocytopenia

Answer

Factor VII Deficiency

Answer

Heparin Therapy

Question 3

Prevalence of Burkitt's lymphoma is highest in which continent?

Accepted Answer

Africa

Answer

Australia

Answer

Asia

Answer

America

Question 4

All of the following are true regarding Von Willebrand's disease EXCEPT:

Accepted Answer

Normal Ristocetin test

Answer

Factor VIII C deficiency

Answer

Bleeding time is prolonged

Answer

Defective platelet aggregation

Question 5

Which assay is best for diagnosing a deficiency of von Willebrand factor?

Accepted Answer

Bleeding time + Activated partial thromboplastin time + von Willebrand factor-ristocetin cofactor assay

Answer

Bleeding time

Answer

Bleeding time + Activated partial thromboplastin time

Answer

Prothrombin time

Question 6

Which of the following is NOT a cytogenetic abnormality found in myelodysplastic syndromes?

Accepted Answer

Chromosome 20q deletion

Answer

Chromosome 5q deletion

Answer

Monosomy 7

Answer

Trisomy 8

Question 7

Direct Coombs test detects which of the following?

Accepted Answer

Antibodies attached to the RBC surface

Answer

Antibodies in the serum

Answer

Antigens attached to the RBC surface

Answer

Antigens in the serum

Question 8

All are true regarding Myelofibrosis EXCEPT?

Accepted Answer

Absence of splenic enlargement

Answer

Tear drop poikilocytes

Answer

Giant abnormal platelets

Answer

Leucoerythroblastic blood picture

Question 9

What is true about smoldering multiple myeloma?

Accepted Answer

Presence of monoclonal gammopathy

Answer

Presence of lytic bone lesions

Answer

Presence of hypercalcemia

Answer

Bone marrow plasma cells less than 10%

Question 10

All are true about splenic marginal zone lymphoma, EXCEPT:

Accepted Answer

The clinical course is virulent.

Answer

Autoimmune anemia or thrombocytopenia is present.

Answer

This tumor of small lymphocytes originates in the marginal zone of the spleen white pulp.

Answer

Splenic hilar nodes are involved.

Hematopathology — MCQs

Hematopathology — MCQs

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