Hematopathology Practice Questions

Q: Aplastic anemia is characterized by which of the following findings?

Normocytic normochromic anemia with thrombocytopenia. **Explanation:** **Aplastic Anemia (AA)** is a bone marrow failure syndrome characterized by **pancytopenia** (reduction in all three cell lines: RBCs, WBCs, and platelets) and a **hypocellular bone marrow** where hematopoietic tissue is replaced by fat. 1. **Why Option A is correct:** In Aplastic Anemia, the primary defect is a reduction in the number of hematopoietic stem cells. Since the cells that *are* produced are typically structurally normal, the red blood cells usually maintain a **normocytic (normal size) and normochromic (normal hemoglobin content)** appearance. Thrombocytopenia is a hallmark finding due to the failure of megakaryopoiesis. 2. **Why other options are incorrect:** * **Option B (Megaloblasts):** These are seen in Megaloblastic Anemias (Vitamin B12 or Folate deficiency) due to impaired DNA synthesis. While AA can sometimes show mild macrocytosis, true megaloblasts are absent. * **Option C (Hypochromic microcytic):** This is characteristic of impaired hemoglobin synthesis, most commonly seen in **Iron Deficiency Anemia** or Thalassemia. * **Option D (Hyperchromic macrocytic):** "Hyperchromic" is a misnomer as RBCs cannot be over-saturated with hemoglobin. Macrocytic changes are seen in B12 deficiency or MDS, but not typically as a defining feature of AA. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow aspiration and **trephine biopsy** (shows "dry tap" and fatty replacement). * **Key Finding:** Reticulocytopenia (low corrected reticulocyte count) indicating lack of RBC production. * **Modified Camitta Criteria:** Used to define "Severe Aplastic Anemia" (Marrow cellularity <25% plus two of: Neutrophils <500/µL, Platelets <20,000/µL, or Reticulocytes <1%). * **Treatment of Choice:** Allogeneic Stem Cell Transplant (in young patients) or Immunosuppressive Therapy (Antithymocyte globulin + Cyclosporine).

Q: Iron deficiency is best demonstrated by?

S. ferritin. **Explanation:** **Serum Ferritin** is the single most accurate and reliable non-invasive test for diagnosing Iron Deficiency Anemia (IDA). Ferritin is the primary storage protein for iron; its levels in the blood are directly proportional to the total body iron stores [1]. A low serum ferritin level (<15–30 ng/mL) is highly specific and indicates depleted iron stores, which is the earliest stage of iron deficiency. **Analysis of Options:** * **RDW (Red Cell Distribution Width):** While RDW increases early in IDA (indicating anisocytosis), it is a non-specific marker. It can also be elevated in Vitamin B12/Folate deficiency or sideroblastic anemia. * **BM (Bone Marrow) Examination:** Historically, Prussian blue staining of bone marrow aspirate was the "Gold Standard" for assessing iron stores (hemosiderin) [1]. However, it is an invasive, painful, and expensive procedure. Examination of the marrow may ultimately be required to assess iron stores directly in difficult cases [2]. * **Differential Leucocyte Count (DLC):** This measures white blood cells and has no diagnostic value in assessing iron status. **NEET-PG High-Yield Pearls:** * **Earliest indicator of IDA:** Increased RDW. * **Best biochemical test/Best screening test:** Serum Ferritin [1]. * **Gold Standard (Invasive):** Bone marrow iron (Prussian blue stain) [1][2]. * **Confirmatory test for IDA:** Response to oral iron therapy (increase in Reticulocyte count within 5–7 days) [2]. * **Note:** Ferritin is an **Acute Phase Reactant**. In the presence of inflammation, infection, or malignancy, ferritin levels may be falsely normal or high despite underlying iron deficiency [2]. In such cases, Transferrin Saturation (<16%) is used.

Q: Platelets can be stored at what temperature and for how long?

20-24°C for 5 days. **Explanation:** The correct answer is **A. 20-24°C for 5 days.** **Underlying Medical Concept:** Platelets are unique among blood components because they must be stored at **room temperature (20-24°C)** with **continuous agitation**. Agitation (via a platelet agitator) is crucial to prevent platelet aggregation and to facilitate gas exchange, maintaining a pH above 6.0. If platelets are refrigerated (4-8°C), they undergo "cold-induced activation" and structural changes (becoming spherical), leading to rapid clearance by the recipient's spleen after transfusion. The 5-day limit is strictly enforced primarily due to the **risk of bacterial proliferation**, which is higher at room temperature compared to refrigerated components. **Analysis of Incorrect Options:** * **B & D (8 days):** Extending storage to 8 days significantly increases the risk of life-threatening bacterial sepsis. While some newer technologies (like pathogen reduction or large-volume delayed sampling) can extend shelf life to 7 days, the standard board-exam answer remains 5 days. * **C & D (4-8°C):** This is the storage temperature for **Whole Blood and Packed Red Blood Cells (PRBCs)**. Refrigeration preserves red cell metabolic activity but renders platelets non-functional for transfusion purposes. **High-Yield Clinical Pearls for NEET-PG:** * **Agitation:** Essential to prevent lactic acidosis and maintain platelet viability. * **Bacterial Sepsis:** Platelets are the blood component most commonly associated with transfusion-transmitted bacterial infections (most common: *Staphylococcus epidermidis*). * **Dose:** One unit of Random Donor Platelets (RDP) typically increases the count by 5,000–10,000/µL, whereas one unit of Single Donor Platelets (SDP) increases it by 30,000–60,000/µL. * **Fresh Frozen Plasma (FFP):** Stored at **-18°C or colder** for up to 1 year.

Q: A 50-year-old male presented with left upper quadrant pain. On examination, the spleen was palpable 10 cm below the left costal margin. A peripheral smear is shown. Which of the following immunohistochemical markers is used for the diagnosis of the condition?

Annexin A1. ***Annexin A1*** - **Annexin A1** is the specific immunohistochemical marker for **hairy cell leukemia (HCL)**, which presents with massive splenomegaly and characteristic "hairy cells" on peripheral smear. - It helps distinguish **classic HCL** from **HCL-variant** and other B-cell lymphomas, making it the diagnostic marker of choice. *CD23* - **CD23** is primarily used as a marker for **chronic lymphocytic leukemia (CLL)** and **small lymphocytic lymphoma**. - CLL typically presents with **lymphadenopathy** rather than massive splenomegaly, and lacks the characteristic hairy cell morphology. *CD21* - **CD21** is a marker for **B-cells** and **follicular dendritic cells**, but is not specific for any particular lymphoid malignancy. - It does not help differentiate **hairy cell leukemia** from other B-cell disorders and lacks diagnostic specificity. *Cyclin D1* - **Cyclin D1** is the characteristic marker for **mantle cell lymphoma**, which has a different clinical presentation and morphology. - Mantle cell lymphoma typically affects **elderly males** with lymphadenopathy and **gastrointestinal involvement**, not isolated massive splenomegaly.

Question 1

Pancytopenia with hypercellular marrow may be seen due to all of the following except:

Accepted Answer

Dyskeratosis congenita

Answer

Myelodysplasia

Answer

Paroxysmal Nocturnal Hemoglobinuria

Answer

Sarcoidosis

Question 2

Aplastic anemia is characterized by which of the following findings?

Accepted Answer

Normocytic normochromic anemia with thrombocytopenia

Answer

Presence of megaloblasts

Answer

Hypochromic microcytic anemia

Answer

Hyperchromic macrocytic anemia

Question 3

Which of the following are types of Hodgkin's lymphoma?

Accepted Answer

Lymphocyte depletion

Answer

Nodular sclerosis

Answer

Mixed cellularity

Answer

Mantle cell lymphoma

Question 4

A 36-year-old male presents with weakness, pallor, and bleeding gums. His HB was 7 g/dL, total leukocyte count was 110,000/mm³ with many immature white blood cells positive for MPO, and platelet count was 22,000/mm³. What is the most likely diagnosis?

Accepted Answer

Acute Myeloid Leukemia (AML)

Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Lymphoid Leukemia (ALL)

Answer

Chronic Lymphoid Leukemia (CLL)

Question 5

Iron deficiency is best demonstrated by?

Accepted Answer

S. ferritin

Answer

RDW

Answer

BM examination

Answer

Differential leucocyte count

Question 6

Microangiopathic hemolytic anemia (MAHA) is a component of all of the following, except?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Hemolytic uremic syndrome (HUS)

Answer

Hemolysis with elevated liver enzymes and low platelet (HELLP) syndrome

Question 7

Bence Jones proteinuria is found on a urinalysis specimen from a 63-year-old woman who is developing chronic renal failure with high serum urea nitrogen and creatinine. A radiograph of the vertebral column demonstrates multiple 1 to 2 cm rounded areas of decreased bone density. The pathological examination from a renal biopsy is likely to show which of the following complications?

Accepted Answer

Amyloidosis

Answer

Pneumocystis carinii pneumonia

Answer

Sclerodactyly

Answer

Chronic myelogenous leukemia

Question 8

A patient presents with a lytic bone lesion. Histology reveals monoclonal plasma cells. Bone marrow biopsy shows less than 10 percent plasma cells, and a small M spike is reported on electrophoresis. Skeletal survey is otherwise unremarkable. What is the most likely diagnosis?

Accepted Answer

Plasmacytoma

Answer

Multiple Myeloma

Answer

Smoldering Myeloma

Answer

Lymphoma

Question 9

Platelets can be stored at what temperature and for how long?

Accepted Answer

20-24°C for 5 days

Answer

20-24°C for 8 days

Answer

4-8°C for 5 days

Answer

4-8°C for 8 days

Question 10

A 50-year-old male presented with left upper quadrant pain. On examination, the spleen was palpable 10 cm below the left costal margin. A peripheral smear is shown. Which of the following immunohistochemical markers is used for the diagnosis of the condition?

Accepted Answer

Annexin A1

Answer

CD23

Answer

CD21

Answer

Cyclin D1

Hematopathology — MCQs

Hematopathology — MCQs

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