Hematopathology Practice Questions

Q: What is the shelf life of gamma-irradiated packed red blood cells (pRBCs)?

28 days. **Explanation:** The shelf life of gamma-irradiated packed red blood cells (pRBCs) is **28 days** from the date of irradiation or the original expiry date of the unit, whichever comes first. **Why 28 days?** Gamma irradiation (usually 25 Gy) is performed to prevent **Transfusion-Associated Graft-Versus-Host Disease (TA-GVHD)** by inactivating donor T-lymphocytes. However, the radiation damages the RBC membrane, leading to increased potassium leakage (hyperkalemia) and a decrease in ATP and 2,3-DPG levels. This accelerated metabolic decay reduces the post-transfusion survival of the RBCs, necessitating a shortened shelf life of 28 days to ensure clinical efficacy and safety. **Analysis of Options:** * **A. 21 days:** This is the shelf life of whole blood or pRBCs collected in **CPD** (Citrate Phosphate Dextrose) anticoagulant without additive solutions. * **C. 35 days:** This is the standard shelf life for pRBCs collected in **CPDA-1** (Citrate Phosphate Dextrose Adenine) anticoagulant. * **D. 42 days:** This is the shelf life for pRBCs stored with **additive solutions** like SAGM (Saline Adenine Glucose Mannitol) or ADSOL. **High-Yield Clinical Pearls for NEET-PG:** * **Indication:** Irradiation is mandatory for immunocompromised patients (e.g., Hodgkin lymphoma, bone marrow transplant), intrauterine transfusions, and directed donations from first-degree relatives. * **Dose:** The central dose of irradiation should be **25 Gray (Gy)**, with no part receiving less than 15 Gy. * **Potassium Warning:** Because irradiation increases extracellular potassium, irradiated units should be transfused immediately (or within 24 hours) in neonatal or large-volume exchange transfusions to avoid cardiac arrhythmias.

Q: What is the MCHC criterion for diagnosing iron deficiency anemia?

<34 g/dL. **Explanation:** **Iron Deficiency Anemia (IDA)** is characterized by a defect in hemoglobin synthesis, leading to a **microcytic hypochromic** blood picture [1]. Mean Corpuscular Hemoglobin Concentration (MCHC) measures the average concentration of hemoglobin in a given volume of packed red blood cells. 1. **Why Option B is correct:** The normal range for MCHC is typically **32–36 g/dL**. In IDA, as hemoglobin synthesis fails, the cells become increasingly pale (hypochromic). A value **<34 g/dL** is the established diagnostic threshold for hypochromia in most clinical and academic textbooks (including Robbins and Wintrobe). It is often the earliest indicator of reduced hemoglobin concentration within the RBCs before significant morphological changes occur. 2. **Analysis of Incorrect Options:** * **Option A (<32 g/dL):** While this value definitely indicates hypochromia, it is considered a more advanced stage of depletion. The diagnostic "cutoff" begins at the lower end of the normal physiological range (<34 g/dL). * **Options C & D (<28 and <30 g/dL):** These represent severe hypochromia. While seen in chronic, untreated IDA, they are not the "criterion" for diagnosis; using these would miss many early cases of IDA. **High-Yield Clinical Pearls for NEET-PG:** * **Earliest Sign of IDA:** Increased **RDW** (Red Cell Distribution Width) is often the first change in the peripheral smear. * **Gold Standard Diagnosis:** Bone marrow aspiration showing absence of stainable iron (**Prussian Blue/Perl’s stain**). * **Mentzer Index:** MCV/RBC count. If **>13**, it suggests IDA; if ** 36 g/dL). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: "Smudge cells" in the peripheral smear are characteristic of?

Chronic lymphocytic leukemia. **Explanation:** **Chronic Lymphocytic Leukemia (CLL)** is the correct answer because smudge cells (also known as basket cells) are the classic morphological hallmark of this condition [1]. **Why Smudge Cells occur in CLL:** In CLL, the peripheral blood is dominated by small, mature-looking B-lymphocytes. However, these neoplastic cells possess an abnormal cytoskeleton, making them extremely fragile [1]. When a peripheral blood film is prepared, the mechanical pressure of the spreader slide causes these fragile lymphocytes to rupture, resulting in crushed nuclei that appear as pale, feathery, eosinophilic "smudges" lacking a defined cell membrane or cytoplasm [1]. **Analysis of Incorrect Options:** * **Chronic Myelogenous Leukemia (CML):** Characterized by a "myeloid bulge" (presence of cells at all stages of granulocytic differentiation) and increased basophils/eosinophils. Cells are generally robust and do not smudge easily. * **Acute Myelogenous Leukemia (AML):** Defined by the presence of myeloblasts, often containing **Auer rods**. * **Acute Lymphoblastic Leukemia (ALL):** While lymphoblasts are present, they do not typically exhibit the extreme fragility seen in the mature B-cells of CLL. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** If smudge cells are numerous, adding a drop of **bovine albumin** to the blood sample before making the smear can stabilize the cells and allow for better visualization of morphology. * **Immunophenotype:** CLL is characterized by the co-expression of **CD5** (a T-cell marker) and **CD19/CD20/CD23** (B-cell markers) [1]. * **Prognosis:** The presence of smudge cells is actually a good prognostic indicator; a higher percentage of smudge cells correlates with longer progression-free survival. **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. 602.

Question 1

A patient presents with microcytic hypochromic anaemia. Laboratory investigations reveal reduced total serum iron, reduced percentage saturation of serum transferrin, and increased serum ferritin levels. What is the most likely diagnosis?

Accepted Answer

Anaemia of chronic disease

Answer

Iron deficiency anaemia

Answer

Sideroblastic anaemia

Answer

Pernicious anaemia

Question 2

In hereditary spherocytosis, an inherited abnormality is seen in which of the following red blood cell components?

Accepted Answer

Spectrin

Answer

A-globin chain

Answer

a-globin chain

Answer

Phosphatidylinositol glycan A

Question 3

Iron levels are decreased in all of the following conditions except:

Accepted Answer

Sideroblastic anemia

Answer

Anemia due to chronic infection

Answer

Anemia due to gastric ulcer (bleeding ulcer)

Answer

Hookworm anemia

Question 4

Splenic infarction is associated with which of the following conditions?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Typhoid

Answer

Infectious mononucleosis

Answer

Chronic Myeloid Leukemia (CML)

Question 5

Which of the following disorders is least likely to be associated with a prolonged bleeding time?

Accepted Answer

Coagulation factor deficiencies

Answer

Thrombocytopenia

Answer

Platelet dysfunction

Answer

Disseminated Intravascular Coagulation (DIC)

Question 6

What condition is characterized by the presence of leptocytes in blood smears?

Accepted Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Post splenectomy

Answer

Uremia

Question 7

All of the following statements about Hodgkin's lymphoma are true EXCEPT?

Accepted Answer

Systemic involvement is more common than in non-Hodgkin's lymphoma.

Answer

It is less aggressive than non-Hodgkin's lymphoma.

Answer

Single lymph node involvement is common.

Answer

Spread occurs in a continuous fashion.

Question 8

What is the shelf life of gamma-irradiated packed red blood cells (pRBCs)?

Accepted Answer

28 days

Answer

21 days

Answer

35 days

Answer

42 days

Question 9

What is the MCHC criterion for diagnosing iron deficiency anemia?

Accepted Answer

<34 g/dL

Answer

<32 g/dL

Answer

<28 g/dL

Answer

<30 g/dL

Question 10

"Smudge cells" in the peripheral smear are characteristic of?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Chronic myelogenous leukemia

Answer

Acute myelogenous leukemia

Answer

Acute lymphoblastic leukemia

Hematopathology — MCQs

Hematopathology — MCQs

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