Hematopathology Practice Questions

Q: Which of the following acute-phase reactants is responsible for the anemia associated with chronic inflammation?

Hepcidin. **Explanation:** The correct answer is **Hepcidin**. **Mechanism of Anemia of Chronic Disease (ACD):** In the setting of chronic inflammation, pro-inflammatory cytokines (primarily **IL-6**) stimulate the liver to synthesize **Hepcidin**, a key iron-regulatory hormone [1]. Hepcidin induces the degradation of **ferroportin**, the only known iron exporter on the surface of enterocytes and macrophages [1]. This leads to: 1. **Decreased intestinal iron absorption.** 2. **Sequestration of iron** within the reticuloendothelial system (macrophages) [1]. Consequently, iron is "trapped" and unavailable for erythropoiesis, leading to a functional iron deficiency despite adequate total body iron stores. **Analysis of Incorrect Options:** * **A. Fibrinogen:** An acute-phase reactant that promotes erythrocyte sedimentation (ESR) by causing "rouleaux" formation, but it does not affect iron metabolism. * **B. Serum amyloid A (SAA):** An apolipoprotein associated with chronic inflammation; its prolonged elevation can lead to secondary (AA) amyloidosis, not anemia. * **C. C-reactive protein (CRP):** A sensitive but non-specific marker of systemic inflammation used to monitor disease activity; it has no direct role in the pathogenesis of anemia. **High-Yield Clinical Pearls for NEET-PG:** * **Hallmark Lab Findings in ACD:** Low Serum Iron, **High Ferritin** (as it is also an acute-phase reactant), and **Low TIBC** (Total Iron Binding Capacity). * **Hepcidin vs. Ferroportin:** Remember, Hepcidin is the "brake" on iron flow; high Hepcidin = Low serum iron [1]. * **Treatment:** The primary treatment for ACD is managing the underlying inflammatory condition. Erythropoietin (EPO) levels are often inappropriately low for the degree of anemia in these patients [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 658-662.

Q: Alpha-naphthyl esterase enzyme is present in which type of leukocyte?

Monocyte. **Explanation:** The correct answer is **Monocyte**. **1. Why Monocyte is correct:** Alpha-naphthyl esterase (ANE) is a **non-specific esterase (NSE)**. These enzymes are characteristic markers for cells of the **monocytic lineage**. In cytochemistry, NSE staining is used to differentiate Acute Myeloid Leukemia (AML) subtypes. Monoblasts and monocytes show strong, diffuse positivity for ANE, which is characteristically **inhibited by the addition of sodium fluoride (NaF)**. This is a crucial diagnostic feature for AML-M4 (Myelomonocytic) and AML-M5 (Monocytic) in the FAB classification. **2. Why other options are incorrect:** * **Neutrophils:** These cells are primarily identified by **Myeloperoxidase (MPO)** and **Specific Esterase** (Naphthol AS-D Chloroacetate esterase). They are generally negative for non-specific esterases like ANE. * **Eosinophils:** These are identified by their distinct granules and are MPO positive. They do not typically express diagnostic levels of ANE. * **Lymphocytes:** While some T-cells may show focal, "dot-like" positivity for ANE, it is not their characteristic marker. Diffuse cytoplasmic staining is specific to monocytes. **3. High-Yield Clinical Pearls for NEET-PG:** * **MPO:** Best marker for **Myeloid** differentiation (AML). * **Specific Esterase (CAE):** Marks **Granulocytic** series (Neutrophils). * **Non-Specific Esterase (ANE/ANAE):** Marks **Monocytic** series; inhibited by **Sodium Fluoride**. * **PAS (Periodic Acid Schiff):** Shows "block positivity" in **L1/L2 ALL** and "smudgy/diffuse" positivity in **AML-M6** (Erythroleukemia). * **LAP Score (Leukocyte Alkaline Phosphatase):** Elevated in Leukemoid reaction; decreased in **CML**.

Q: Which stain is used for the diagnosis of granulocytic sarcoma?

Myeloperoxidase. **Explanation:** **Granulocytic Sarcoma** (also known as **Chloroma** or Myeloid Sarcoma) is an extramedullary tumor mass composed of immature myeloid cells. It is most commonly associated with Acute Myeloid Leukemia (AML), particularly the M2, M4, and M5 subtypes. **Why Myeloperoxidase (MPO) is the correct answer:** MPO is the most sensitive and specific marker for cells of the **myeloid lineage**. Since granulocytic sarcoma consists of myeloblasts and maturing granulocytes, MPO staining (either via cytochemistry or immunohistochemistry) is the gold standard for confirming the myeloid nature of the tumor cells and differentiating it from lymphomas. **Analysis of Incorrect Options:** * **Leucocyte Alkaline Phosphatase (LAP):** This enzyme is found in mature neutrophils. The LAP score is used to differentiate Leukemoid Reaction (High score) from Chronic Myeloid Leukemia (Low score). It is not used to identify immature blasts in a sarcoma. * **Non-specific Esterase (NSE):** This stain is a marker for the **monocytic lineage**. While it may be positive in the myelomonocytic variant of myeloid sarcoma, MPO remains the primary diagnostic stain for the "granulocytic" type. * **Neuron Specific Enolase (NSE):** This is a marker for neuroendocrine tumors and small cell carcinomas, having no role in the diagnosis of myeloid neoplasms. **High-Yield Clinical Pearls for NEET-PG:** * **Common Site:** Often involves the bone, periosteum, soft tissues, and lymph nodes. * **Cytogenetics:** Frequently associated with **t(8;21)** [1]. * **Nomenclature:** The term "Chloroma" is derived from the greenish color of the tumor caused by the presence of the MPO enzyme itself. * **Other Markers:** CD33, CD117 (c-kit), and Lysozyme are also typically positive. **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, p. 620.

Q: A 40-year-old female patient presents with excessive bleeding following a road traffic accident 5 hours prior, with a lacerated wound on the lower back. Blood grouping tests reveal the presence of Anti-A antibody, Anti-B antibody, Anti-H antibody, and Anti-Rh D antibody in her serum. What is the blood group of this patient?

Bombay blood group. **Explanation:** The correct answer is **Bombay blood group (Oh phenotype)**. **1. Why the Bombay blood group is correct:** The key to this question lies in the presence of **Anti-H antibodies**. In the ABO biosynthetic pathway, the **H substance** (formed by the action of fucosyltransferase on a precursor chain) is the essential substrate upon which A and B antigens are built. * Individuals with the **Bombay phenotype (hh)** lack the *H gene*; therefore, they cannot produce H substance. * Because they lack H substance, they cannot produce A or B antigens, even if they possess the A or B genes. * Consequently, their serum contains naturally occurring, potent, high-titer **Anti-A, Anti-B, and Anti-H antibodies** [1]. Since the patient also has Anti-Rh D, she is Rh-negative. **2. Why the other options are incorrect:** * **O Positive/Negative:** Individuals with blood group O possess the **H antigen** (in fact, they have the highest concentration of H substance). Therefore, they **do not** produce Anti-H antibodies. * **AB Positive:** These individuals have A, B, and H antigens on their RBCs; their serum contains no antibodies against these antigens [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Discovery:** First described by Bhende in Mumbai (1952). * **Genotype:** *hh* (autosomal recessive inheritance). * **Testing Pitfall:** On routine forward grouping, Bombay blood group mimics **Group O** because it lacks A and B antigens. It is only identified during **reverse grouping** (cross-matching) because it reacts with O-group cells (due to Anti-H). * **Transfusion:** Patients can **only** receive blood from another Bombay phenotype individual. * **Secretor Status:** They are always non-secretors. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628.

Question 1

A patient presents with painless lymphadenopathy. A biopsy reveals binucleated owl-shaped nuclei with a clear vacuolated area. Immunohistochemistry shows positivity for CD15 and CD30. What is the most probable diagnosis?

Accepted Answer

Nodular sclerosis

Answer

Large granular lymphocytic lymphoma

Answer

Lymphocyte depletion type

Answer

Lymphocyte predominant Hodgkin lymphoma

Question 2

Helmet cells are characteristic of which of the following conditions?

Accepted Answer

Hemolytic uremic syndrome

Answer

Polysplenia

Answer

Spherocytosis

Answer

Acanthocytosis

Question 3

Which of the following acute-phase reactants is responsible for the anemia associated with chronic inflammation?

Accepted Answer

Hepcidin

Answer

Fibrinogen

Answer

Serum amyloid A (SAA)

Answer

C-reactive protein (CRP)

Question 4

Alpha-naphthyl esterase enzyme is present in which type of leukocyte?

Accepted Answer

Monocyte

Answer

Neutrophil

Answer

Eosinophil

Answer

Lymphocyte

Question 5

Warm-antibody immunohemolytic anemia is seen in all of the following conditions except?

Accepted Answer

Infectious mononucleosis

Answer

Systemic lupus erythematosus

Answer

Alpha-methyl-dopa ingestion

Answer

Quinidine

Question 6

Which marker is used to assess monoclonality in T-cells?

Accepted Answer

TCR gene rearrangement

Answer

Kappa and Lambda chain

Answer

CD

Answer

CD34

Question 7

Which stain is used for the diagnosis of granulocytic sarcoma?

Accepted Answer

Myeloperoxidase

Answer

Leucocyte alkaline phosphatase

Answer

Non specific esterase

Answer

Neuron specific esterase

Question 8

Basophilic stippling of red blood cells is a finding associated with which of the following enzymatic deficiencies?

Accepted Answer

5' nucleotidase deficiency

Answer

ALA synthetase deficiency

Answer

Ferrochelatase deficiency

Answer

ALA dehydrogenase deficiency

Question 9

A 40-year-old female patient presents with excessive bleeding following a road traffic accident 5 hours prior, with a lacerated wound on the lower back. Blood grouping tests reveal the presence of Anti-A antibody, Anti-B antibody, Anti-H antibody, and Anti-Rh D antibody in her serum. What is the blood group of this patient?

Accepted Answer

Bombay blood group

Answer

O positive

Answer

O negative

Answer

AB positive

Question 10

Which of the following conditions typically shows an elevated Erythrocyte Sedimentation Rate (ESR)?

Accepted Answer

Multiple myeloma and Acute myocardial infarction

Answer

Multiple myeloma

Answer

Sickle cell anemia and Multiple myeloma

Answer

Sickle cell anemia and Angina pectoris

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?