Hematopathology Practice Questions

Q: Which of the following is the most common chromosomal abnormality associated with acute myeloid leukemia (AML) with a favorable prognosis?

t(15;17) - PML-RARA fusion. ***t(15;17)*** - This translocation defines **Acute Promyelocytic Leukemia (APL)**, a distinct and highly curable subtype of AML, making its prognosis the most favorable [1]. - It results in the expression of the chimeric **PML/RARA fusion gene**, which is highly sensitive to differentiation agents like **all-trans retinoic acid (ATRA)**, leading to high cure rates [1]. *t(8;21) and inv(16) are also associated with a favorable prognosis, but t(15;17) often has the best outcome* - The **t(8;21)** and **inv(16)**/t(16;16) are classified as favorable or core-binding factor (CBF) AMLs, indicating good responsiveness to chemotherapy [1]. - Prognosis for CBF AML is superior to intermediate-risk AML, but generally not as excellent as APL treated with ATRA and arsenic. *Monosomy 7 (-7)* - The loss of chromosome 7 is a hallmark chromosomal abnormality associated with the **adverse risk** group in AML, indicating a significantly poor prognosis. - It is frequently observed in patients with pre-existing **Myelodysplastic Syndrome (MDS)** or **therapy-related AML (t-AML)**. *t(9;22)* - While this translocation is famous for defining **Chronic Myeloid Leukemia (CML)** (leading to the **BCR-ABL1** fusion gene), its presence in AML is generally associated with a complex karyotype or mixed-phenotype acute leukemia. - Its presence in AML usually confers a less favorable or **adverse prognosis**, unlike the highly favorable t(15;17). **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. 620-621.

Q: A lymphoma characterized by the presence of centrocytes and centroblasts, along with BCL2 positivity and CD10 expression, is most commonly associated with which chromosomal translocation?

t(14 ; 18). ***t(14 ; 18)*** [1], [2] - This translocation is the genetic hallmark of **Follicular Lymphoma (FL)**, characterized by the presence of **centrocytes** and **centroblasts**, **BCL2 positivity**, and **CD10 expression** [1], [2]. - It results in the juxtaposition of the **BCL2 gene** (on chromosome 18) with the **IgH locus** (on chromosome 14), leading to constitutive overexpression of the anti-apoptotic BCL2 protein [1], [2]. *t(2 ; 5)* - This translocation is characteristic of **Anaplastic Large Cell Lymphoma (ALCL)**, leading to the activation of the **ALK gene**. - ALCL is typically **CD30 positive** and lacks the centrocytes/centroblasts morphology and germinal center markers (like CD10) seen in the described B-cell lymphoma. *t(11 ; 14)* - This translocation is associated with **Mantle Cell Lymphoma (MCL)**, causing the overexpression of **Cyclin D1**. - While MCL cells are often BCL2 positive, they typically lack **CD10 expression**, which is a key feature of the described germinal center lymphoma. *t(8 ; 14)* - This translocation is the hallmark of **Burkitt Lymphoma**, resulting in **MYC gene** overexpression. - Burkitt Lymphoma is typically **CD10 positive** but shows a high proliferation index (Ki-67 ~100%) and lacks BCL2 expression [3], unlike the described follicular lymphoma. **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. 602-604. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 561-562. [3] 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. 606.

Q: The following image shows:

Jamshidi needle. ***Jamshidi needle*** - The image displays a needle with a **tapered, open-ended tip** and a stylet, characteristic features of a Jamshidi needle, which is used for **bone marrow biopsy**. - The **winged hub** provides a secure grip and improved control during insertion and rotation. *Epidural needle* - An epidural needle typically has a **blunt, curved (Tuohy) tip** designed to push aside tissues and reduce the risk of puncturing the dura mater. - The tip shown in the image is sharp and tapered, not blunt or curved. *Pleural biopsy needle* - Pleural biopsy needles (e.g., Abrams needle) often have a **cutting mechanism** or a special design to obtain a tissue sample from the pleura, which is not evident in this image. - While some biopsy needles can be long, their tips are specifically adapted for cutting or grasping pleural tissue. *Quincke's needle* - A Quincke's needle is a type of spinal needle characterized by a **sharp, beveled tip** with an opening on the side, used for lumbar punctures to access cerebrospinal fluid. - The needle in the image has a different tip design, primarily for coring tissue, not for aspiration of fluid through a side port.

Q: The following test is performed for which condition?

Paroxysmal nocturnal haemoglobinuria. ***Paroxysmal nocturnal haemoglobinuria*** - The image depicts the **Ham test**, also known as the acid serum lysis test, which is historically used to diagnose **paroxysmal nocturnal hemoglobinuria (PNH)**. - In PNH, red blood cells are abnormally susceptible to complement-mediated lysis in acidified serum, leading to **hemolysis** as seen in the test tube with red fluid. *Hemoglobinopathy* - Hemoglobinopathies are characterized by **abnormal hemoglobin structures** or synthesis, such as sickle cell anemia or thalassemia. - While they can cause hemolytic anemia, their diagnosis involves **hemoglobin electrophoresis** or genetic testing, not the Ham test. *Alkaptonuria* - Alkaptonuria is a rare genetic disorder of metabolism affecting the breakdown of **tyrosine and phenylalanine**, leading to accumulation of homogentisic acid. - It results in **dark urine** upon standing and pigmentation of connective tissues (ochronosis), and is not diagnosed by tests for hemolysis. *Paroxysmal cold haemoglobinuria* - This condition is characterized by **hemolysis following cold exposure**, mediated by anti-P cold agglutinin antibodies. - Diagnosis involves the **Donath-Landsteiner test**, which demonstrates hemolysis at cold temperatures and warming, rather than the Ham test.

Q: All are true about the blood component shown below except?

Random donor platelets are produced by apheresis. ***Random donor platelets are produced by apheresis*** - **Random donor platelets** are typically prepared from **whole blood donations** by centrifugation, not apheresis. - **Apheresis** is a process used to collect specific blood components, such as platelets, from a single donor, resulting in a single-donor apheresis platelet unit, not random donor platelets. *Infusion must be completed within 30 minutes* - The recommended infusion time for platelets is generally **30-60 minutes**. - Rapid infusion (under 30 minutes) is usually not recommended and could potentially lead to adverse reactions or compromise platelet viability. *Use of leukocyte filters helps in reducing allosensitization* - **Leukocyte reduction** significantly reduces the number of white blood cells in platelet products. - This helps to decrease the risk of **febrile non-hemolytic transfusion reactions** and **alloimmunization** (allosensitization) to HLA antigens. *Two units of transfused platelets per square meter body surface area are anticipated to increase the platelet count by approximately 10,000/μL* - This statement accurately describes the expected **platelet increment** from standard random donor platelet transfusions. - The increment can vary based on factors such as patient condition and consumption, but this is a general guideline for adequate response.

Q: Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

CD1A positivity. ***CD1A positivity*** - The skull X-ray shows multiple punched-out lytic lesions without sclerotic borders, characteristic of **Langerhans Cell Histiocytosis (LCH)**. - **Langerhans cells** in LCH express surface markers like **CD1a** and S100 protein, which are diagnostic when detected via **immunohistochemistry on tissue biopsy**. - CD1a positivity is the **gold standard** for confirming LCH diagnosis. *Elevated SAP* - **Serum Alkaline Phosphatase (SAP)** is typically elevated in conditions with increased osteoblastic activity or liver/biliary disease. - LCH lesions are generally **lytic** and not associated with increased osteoblastic activity, thus SAP elevation is not a specific or common finding. *Bence Jones proteins* - **Bence Jones proteins** (monoclonal light chains) are found in the urine of patients with **Multiple Myeloma**, which can also cause lytic bone lesions. - However, the image shows more discrete, "punched-out" lesions typical of LCH, whereas myeloma lesions are often more diffuse or "salt-and-pepper" in appearance, and LCH does not secrete Bence Jones proteins. *Elevated HbA2* - **Elevated HbA2** is a characteristic finding in **beta-thalassemia trait**, a genetic blood disorder. - There is no clinical or radiological indication in the provided image or question to suggest a connection to thalassemia.

Q: A 10-year-old Sindhi boy presents with recurrent episodes of bone pain. Specimen shows:

Spleen infarction. ***Spleen infarction*** - The image shows a **wedge-shaped, pale area** within the spleen, consistent with an **infarct**. Splenic infarctions are common in conditions leading to **vaso-occlusion**, such as **sickle cell disease**. - A 10-year-old Sindhi boy with **recurrent bone pain** suggests a **hemoglobinopathy**, particularly sickle cell disease (or a related condition like **thalassemia-sickle beta**), where red blood cells can obstruct splenic blood vessels leading to infarction. *Liver hematoma* - A **hematoma** is a collection of blood, often caused by trauma or hemorrhage. The image depicts a **necrotic area** (infarct) rather than a blood clot within the liver. - While liver issues can occur in some hematologic disorders, the characteristic wedge shape points away from a simple hematoma. *Heart infarction* - A **heart infarction** (myocardial infarction) affects the heart muscle. The specimen in the image is clearly an **abdominal organ**, identifiable as the spleen due to its characteristic shape and internal architecture. - The clinical presentation of bone pain is not directly indicative of a heart infarction. *Adrenal hemorrhage* - **Adrenal hemorrhage** would involve bleeding within the adrenal glands, which are small glands located on top of the kidneys. The organ shown in the image is much larger and shaped like a spleen. - Bone pain is not a typical symptom of adrenal hemorrhage.

Question 1

Which of the following is the most common chromosomal abnormality associated with acute myeloid leukemia (AML) with a favorable prognosis?

Accepted Answer

t(15;17) - PML-RARA fusion

Answer

t(8;21) - RUNX1-RUNX1T1 fusion

Answer

t(9;22) - BCR-ABL fusion

Answer

Trisomy 21

Question 2

A 68-year-old man presents with bleeding manifestations. Peripheral smear shows the presence of cells shown below. Which of the following is the most common chromosomal abnormality seen in this condition?

Accepted Answer

t(15 ; 17)

Answer

t(14 ; 18)

Answer

inv(16)

Answer

t(8 ; 21)

Question 3

Which of the following laboratory techniques is most commonly used to compare and quantify CD markers on cells?

Accepted Answer

Flow cytometry

Answer

Western blot

Answer

ELISA

Answer

Immunohistochemistry

Question 4

A lymphoma characterized by the presence of centrocytes and centroblasts, along with BCL2 positivity and CD10 expression, is most commonly associated with which chromosomal translocation?

Accepted Answer

t(14 ; 18)

Answer

t(2 ; 5)

Answer

t(11 ; 14)

Answer

t(8 ; 14)

Question 5

The following image shows:

Accepted Answer

Jamshidi needle

Answer

Epidural needle

Answer

Pleural biopsy needle

Answer

Quincke's needle

Question 6

The following test is performed for which condition?

Accepted Answer

Paroxysmal nocturnal haemoglobinuria

Answer

Hemoglobinopathy

Answer

Alkaptonuria

Answer

Paroxysmal cold haemoglobinuria

Question 7

A 3-year-old child presents with bleeding from nose and Periorbital Ecchymosis. Sternal tenderness and bone pain is present. Peripheral smear shows presence of fragmented RBC and helmet cells. The most probable diagnosis is? (Recent NEET Pattern 2016-17)

Accepted Answer

Acute myeloid Leukemia

Answer

Acute Idiopathic thrombocytopenic purpura

Answer

Hemophilia A

Answer

Battered baby syndrome

Question 8

All are true about the blood component shown below except?

Accepted Answer

Random donor platelets are produced by apheresis

Answer

Infusion must be completed within 30 minutes

Answer

Use of leukocyte filters helps in reducing allosensitization

Answer

Two units of transfused platelets per square meter body surface area are anticipated to increase the platelet count by approximately 10,000/μL

Question 9

Which of the following will be the most probable diagnostic finding in the patient with X-Ray skull shown below?

Accepted Answer

CD1A positivity

Answer

Elevated SAP

Answer

Bence Jones proteins

Answer

Elevated HbA2

Question 10

A 10-year-old Sindhi boy presents with recurrent episodes of bone pain. Specimen shows:

Accepted Answer

Spleen infarction

Answer

Liver hematoma

Answer

Heart infarction

Answer

Adrenal hemorrhage

Hematopathology — MCQs

Hematopathology — MCQs

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