Hematopathology Practice Questions

Q: Pappenheimer bodies are composed of:

Iron. **Explanation:** **Pappenheimer bodies** are abnormal basophilic granules found in red blood cells. They are composed of **ferritin (iron) aggregates** that have not been incorporated into hemoglobin [1]. 1. **Why Iron is Correct:** Under normal conditions, iron is transported to the mitochondria for heme synthesis. When there is iron overload or impaired utilization (as seen in Sideroblastic anemia), non-heme iron accumulates in the mitochondria. On a peripheral smear stained with **Wright-Giemsa**, these appear as small, irregular, dark-blue granules usually located at the periphery of the cell. Their identity as iron is confirmed using the **Prussian Blue (Perls') stain**, where they are referred to as **Siderotic granules**. 2. **Why Other Options are Incorrect:** * **Copper:** While copper deficiency can lead to sideroblastic-like changes, the bodies themselves are not made of copper. * **Lead:** Lead poisoning inhibits heme synthesis and causes **Basophilic Stippling**, which consists of **ribosomal precipitates (RNA)**, not iron. * **Zinc:** Excess zinc can cause a secondary copper deficiency, but it does not form intra-erythrocytic inclusions. **Clinical Pearls for NEET-PG:** * **Differential Diagnosis:** Pappenheimer bodies are most commonly seen in **Sideroblastic anemia**, **Splenectomy** (due to loss of splenic "pitting"), and **Hemolytic anemias**. * **Staining Distinction:** * **Wright-Giemsa:** Called Pappenheimer bodies. * **Prussian Blue:** Called Siderotic granules. * **Comparison:** Do not confuse with **Howell-Jolly bodies** (DNA remnants) or **Heinz bodies** (Denatured hemoglobin, seen in G6PD deficiency). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 658-659.

Q: Activated protein C resistance disorder is due to inactivation of which factor?

Factor 5. **Explanation:** **Activated Protein C (APC) Resistance** is most commonly caused by a specific genetic mutation known as **Factor V Leiden** [1]. In a normal physiological state, Protein C is activated to APC, which acts as a natural anticoagulant by degrading and inactivating **Factor Va** and Factor VIIIa. In patients with Factor V Leiden, a point mutation (substitution of arginine by glutamine at position 506) alters the cleavage site on the Factor V molecule. This makes Factor V resistant to inactivation by APC. Consequently, Factor Va remains active in the circulation for longer periods, leading to a hypercoagulable state and an increased risk of venous thromboembolism (VTE) [1]. **Analysis of Incorrect Options:** * **Option A (Factor 8):** While APC does normally inactivate Factor VIIIa, "APC Resistance" specifically refers to the inherited defect in the Factor V molecule that prevents its degradation. * **Option C (Factor 13):** Factor XIII is the fibrin-stabilizing factor responsible for cross-linking fibrin clots. It is not the target of the APC resistance mechanism. * **Option D (Factor 4):** Platelet Factor 4 (PF4) is involved in heparin-induced thrombocytopenia (HIT) and platelet aggregation, but it has no role in the Protein C anticoagulant pathway. **High-Yield Clinical Pearls for NEET-PG:** * **Factor V Leiden** is the **most common** inherited cause of hypercoagulability (thrombophilia) in Caucasians [1]. * **Inheritance:** Autosomal Dominant. * **Screening Test:** Functional APC resistance assay (clotting-based). * **Confirmatory Test:** Genetic testing (PCR) for the G1691A mutation in the Factor V gene. * **Clinical Presentation:** Recurrent Deep Vein Thrombosis (DVT) and pulmonary embolism. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Cardiovascular Disease, pp. 281-282.

Question 1

A 40-year-old male presented with massive splenomegaly and mild hepatic enlargement. Peripheral blood film shows cells with hair-like projections that are positive for CD25 and CD103, and negative for CD23. What is the likely diagnosis?

Accepted Answer

Peripheral B-cell neoplasm

Answer

Precursor B-cell neoplasm

Answer

Precursor T-cell neoplasm

Answer

Peripheral T-cell neoplasm

Question 2

Which of the following organ involvements is not commonly observed with CNS involvement in a patient with Diffuse Large B-cell Lymphoma (DLBCL)?

Accepted Answer

Ovary

Answer

Testis

Answer

Kidney

Answer

Adrenal

Question 3

Translocation of the bcr-abl gene is characteristically seen in which of the following conditions?

Accepted Answer

Chronic myeloid leukemia

Answer

Acute myeloid leukemia

Answer

Chronic lymphatic leukemia

Answer

Acute lymphatic leukemia

Question 4

Pappenheimer bodies are composed of:

Accepted Answer

Iron

Answer

Copper

Answer

Lead

Answer

Zinc

Question 5

All of the following infections may be transmitted by blood transfusion, except?

Accepted Answer

Dengue virus

Answer

Parvovirus B-19

Answer

Cytomegalovirus

Answer

Hepatitis G virus

Question 6

Which of the following leukemias is associated with a "convent girl" appearance?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Chronic myelogenous leukemia

Answer

Hairy cell leukemia

Answer

Diffuse large B cell lymphoma

Question 7

Bone marrow aspiration is not indicated in which of the following conditions?

Accepted Answer

Thalassemia major

Answer

Megaloblastic anemia

Answer

Idiopathic thrombocytopenic purpura

Answer

Pure red cell aplasia

Question 8

Activated protein C resistance disorder is due to inactivation of which factor?

Accepted Answer

Factor 5

Answer

Factor 8

Answer

Factor 13

Answer

Factor 4

Question 9

A patient with postpartum hemorrhage had about 2 liters of blood loss. Investigation revealed normal PT and a prolonged aPTT. Which test is used to differentiate between coagulation factor deficiency and a factor inhibitor?

Accepted Answer

Mixing studies

Answer

Tissue thromboplastin inhibition time

Answer

Ecarin clotting time

Answer

Dilute Russel viper venom time

Question 10

The mode of inheritance in hemophilia is

Accepted Answer

X linked recessive

Answer

Autosomal dominant

Answer

Autosomal recessive

Answer

X linked dominant

Hematopathology — MCQs

Hematopathology — MCQs

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