Hematopathology Practice Questions

Q: Necrotizing lymphadenitis is seen in

Kikuchi-Fujimoto disease. ***Kikuchi-Fujimoto disease*** - Kikuchi-Fujimoto disease (KFD), also known as **histiocytic necrotizing lymphadenitis**, is characterized by **necrotizing lymphadenitis** without granulocytic infiltration. - It typically presents with **cervical lymphadenopathy**, fever, and leukopenia, often in young women. *Kimura disease* - Kimura disease is characterized by chronic, painless **subcutaneous masses** and **lymphadenopathy**, often in the head and neck. - Histologically, it shows **follicular hyperplasia** and prominent **eosinophilic infiltration**, not necrotizing lymphadenitis. *Castleman disease* - Castleman disease is a group of rare disorders that involve **overgrowth of lymph node cells**, leading to enlarged lymph nodes. - Histologically, it presents with **hyaline vascular** or **plasma cell variants**, but not necrotizing changes. *Hodgkin's lymphoma* - Hodgkin's lymphoma is a type of cancer characterized by the presence of **Reed-Sternberg cells** within a heterogeneous inflammatory infiltrate. - While it affects lymph nodes, its characteristic features are specific giant cells and an inflammatory background, **not necrotizing lymphadenitis** as the primary finding [1]. **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. 592-593.

Q: Rosenthal's syndrome is due to deficiency of

XI. XI - **Rosenthal's syndrome**, also known as **Hemophilia C**, is an autosomal recessive disorder caused by a deficiency of **Factor XI (FXI)**. - This deficiency leads to a mild bleeding disorder, often characterized by **post-traumatic or postsurgical bleeding**, but spontaneous bleeding is rare. IX - Deficiency of **Factor IX** causes **Hemophilia B** (Christmas disease), an X-linked recessive bleeding disorder [1]. - Hemophilia B typically causes **moderate to severe bleeding** symptoms, including spontaneous joint and muscle bleeds [1]. VIII - Deficiency of **Factor VIII** causes **Hemophilia A** (classic hemophilia), the most common severe X-linked recessive bleeding disorder [1]. - Patients with Hemophilia A experience diverse bleeding manifestations, including **hemarthroses** (joint bleeding) and **deep muscle hematomas** [1]. XII - Deficiency of **Factor XII (Hageman factor)** is associated with a **prolonged activated partial thromboplastin time (aPTT)** but generally does not cause a bleeding disorder. - Patients with F XII deficiency are often **asymptomatic** and do not experience abnormal bleeding, though some may have an increased risk of thrombosis.

Q: Cause of ITP is

Antibody to platelets. The cause of ITP is: ***Antibody to platelets*** - **Immune thrombocytopenic purpura (ITP)** is an autoimmune disorder [1] characterized by the destruction of platelets due to the presence of **autoantibodies**, primarily targeting platelet surface glycoproteins like **GPIIb/IIIa**. - These antibodies lead to premature destruction or increased consumption [1] of platelets by the reticuloendothelial system, particularly in the spleen, resulting in **thrombocytopenia**. *Vasculitis* - **Vasculitis** is inflammation of the blood vessels, which can cause symptoms like purpura but typically does not primarily cause isolated severe thrombocytopenia as seen in ITP. - While it can lead to bleeding manifestations, the underlying mechanism is vascular inflammation, not direct platelet destruction by antibodies. *Antibody to vascular epithelium* - Antibodies to **vascular endothelium** are seen in conditions such as some forms of vasculitis or autoimmune disorders like lupus, but they directly target vessel walls, not platelets. - This typically leads to endothelial damage and inflammation, rather than isolated thrombocytopenia from platelet destruction. *Antibody to clotting factors* - Antibodies to **clotting factors** (e.g., Factor VIII inhibitors) cause **hemophilia-like bleeding disorders** by interfering with the coagulation cascade. - This mechanism results in impaired clot formation, not primarily in low platelet counts as is characteristic of ITP.

Q: Necrotizing lymphadenopathy is characteristically seen in:

Kikuchi disease. ***Kikuchi disease*** - Also known as **histiocytic necrotizing lymphadenitis**, it is characterized by **tender cervical lymphadenopathy** with histological evidence of **necrotizing lymphadenitis** with an influx of **histiocytes and immunoblasts**. - The disease is **self-limiting**, typically resolving in 1-4 months, though it can recur and is more common in **young women of Asian descent**. - Histology shows **paracortical necrosis** with abundant karyorrhectic debris and absence of neutrophils. *Non-Hodgkin's lymphoma* - This is a diverse group of **malignancies** originating from lymphocytes, primarily presenting as **lymphadenopathy** that is typically **painless** and can be widespread. - While some aggressive NHL subtypes may show areas of necrosis, the defining characteristic is **clonal proliferation of malignant lymphocytes** rather than the necrotizing histiocytic features of Kikuchi disease. *Castleman's disease* - This is a rare disorder characterized by the **overgrowth of lymphoid tissue**, presenting with **large, often solitary lymph nodes** (unicentric form) or generalized lymphadenopathy (multicentric form). - It is histologically distinguished by **hypervascularity** and **abnormal germinal centers** (onion-skinning pattern), not by necrotizing lymphadenopathy. *Kimura disease* - A **rare chronic inflammatory disorder** presenting with **subcutaneous nodules** and **lymphadenopathy**, commonly in the head and neck region [1]. - Histologically, it is characterized by **lymphoid hyperplasia with prominent eosinophilic infiltration** and increased vascularity, but **not necrosis** of lymph nodes [1]. **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. 592-593.

Q: Which of the following is true about iron deficiency anemia?

Microcytic hypochromic anemia. ***Microcytic hypochromic anemia*** - **Iron deficiency anemia** is characterized by red blood cells that are **smaller than normal (microcytic)** and **paler than normal (hypochromic)** due to insufficient hemoglobin [1]. - This morphology is a classic finding on a **peripheral blood smear** and reflects the impaired heme synthesis caused by iron depletion [1]. *Bone marrow iron stores are depleted before serum iron levels drop* - This statement is incorrect because **serum ferritin levels**, which reflect **iron stores**, are typically the first to decrease, even before changes in serum iron or hemoglobin are evident. - **Bone marrow iron stores** (assessed by biopsy) would also be depleted early on, but changes in serum ferritin and iron saturation can be detected before a significant drop in serum iron. *TIBC is typically decreased in this condition* - This is incorrect; **total iron-binding capacity (TIBC)** is typically **increased** in iron deficiency anemia, not decreased. - The liver produces more **transferrin** (the protein that binds iron) in an attempt to capture any available iron, leading to a higher TIBC. *Ferritin levels are elevated in this condition* - This is incorrect; **ferritin levels** are typically **decreased** in iron deficiency anemia. - **Ferritin** is a storage protein for iron, and its levels correlate with the body's iron stores, so a low ferritin is indicative of iron deficiency.

Q: Which of the following stains is used for reticulocyte staining?

Brilliant cresyl blue. **Correct Answer: Brilliant cresyl blue** - **Brilliant cresyl blue** is a **supravital stain** commonly used to visualize **reticulocytes** [1] - It precipitates the **ribosomal RNA** and other organelles present in reticulocytes, making them visible as a **reticular network** within the cell - This is one of the two most common stains used for reticulocyte counting (along with New methylene blue) *Incorrect: Indigo carmine* - **Indigo carmine** is a vital dye used for diagnostic procedures in **gastroenterology and urology** (e.g., to detect mucosal lesions or assess kidney function) - Used in endoscopic procedures as a **chromoscopic agent** to enhance visualization, but not for reticulocyte staining *Incorrect: Sudan black* - **Sudan black B** is a stain primarily used for detecting **lipids** and **lipofuscin** in various cells and tissues - Often utilized in **hematology** to differentiate myeloid cells from lymphoid cells based on their granule content, but not for reticulocytes *Incorrect: Methyl violet* - **Methyl violet** is a basic dye used as a **histological stain** and for staining **Gram-positive bacteria** in bacteriology - While it can stain cellular components, it is not specifically used for the identification or enumeration of reticulocytes **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-579.

Q: ALL L3 morphology is a malignancy arising from which cell lineage –

Mature B cell. ***Mature B cell*** - ALL L3, also known as **Burkitt-type ALL**, arises from a **mature B-cell lineage**. [1] - This is characterized by specific immunophenotypic markers (e.g., strong expression of **surface immunoglobulin** and **CD20**) and frequent chromosomal translocations involving the **MYC oncogene**, typically t(8;14). [1] *Mixed B cell & T cell* - This refers to **mixed phenotype acute leukemia (MPAL)**, which exhibits features of both B-cell and T-cell lineages. - MPAL is distinct from ALL L3, which is definitively B-cell in origin based on morphology and immunophenotype. *Immature T cell* - Malignancies arising from immature T cells are classified as **T-cell ALL**, which have a different morphology (L1 or L2) and distinct immunophenotype (e.g., expression of **cytoplasmic CD3**, CD1a, CD2, CD5, CD7). [1] - T-cell ALL is characterized by **T-cell receptor gene rearrangements** and typically presents with a mediastinal mass, unlike ALL L3. [1] *Precursor B cell* - Most cases of ALL (ALL L1 and L2) arise from **precursor B cells**, also known as B-lymphoblastic leukemia. [2] - These are characterized by lack of surface immunoglobulin expression and generally express **CD10, CD19, CD22**, and **TdT**, contrasting with the mature B-cell immunophenotype of ALL L3. [2] **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. 606. [2] 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. 596-598.

Q: Packed red cells are commonly stored in which preservative solution?

CPDA-1 solution. ***Correct: CPDA-1 solution*** - **CPDA-1** (Citrate-Phosphate-Dextrose-Adenine) is the standard anticoagulant and preservative solution taught in Indian medical curricula - Allows storage of packed red cells for **35 days** at 1-6°C - Contains citrate (anticoagulant), phosphate (buffer), dextrose (RBC energy), and adenine (ATP synthesis) - Most commonly referenced in NEET-PG examinations as the standard storage solution *AS-1 (Adsol) solution* - Additive solution used primarily in the United States for extended PRBC storage (42 days) - Added to red cells after plasma removal to maintain viability - While effective, it is not the primary solution taught in standard Indian medical education *SAG-M solution* - **SAG-M** (Saline-Adenine-Glucose-Mannitol) is an additive solution used primarily in Europe - Extends packed red cell storage to **42 days** - Functionally similar to other additive solutions but less commonly referenced in Indian medical curriculum *AS-3 (Nutricel) solution* - Another additive solution for red blood cell storage used in the US - Designed to extend shelf life to 42 days - Like AS-1, it is not the standard preservative solution taught in Indian medical education **Note:** Modern blood banking increasingly uses additive solutions (AS-1, AS-3, SAG-M) for extended storage, but CPDA-1 remains the fundamental preservative solution taught in medical education.

Q: Glycoprotein IIb-IIIa complex is deficient in

Glanzmann disease. ***Glanzmann disease*** - This condition is characterized by a deficiency or qualitative defect of the **glycoprotein IIb-IIIa (GPIIb-IIIa) complex** on the platelet surface [1]. - The GPIIb-IIIa complex is crucial for **platelet aggregation** as it acts as a receptor for **fibrinogen**, connecting platelets [1], [2]. *Bernard-Soulier syndrome* - This syndrome involves a deficiency of the **glycoprotein Ib-IX-V complex**, which is responsible for **platelet adhesion** to **von Willebrand factor (vWF)** on the subendothelium [1], [2]. - Patients present with **large platelets** and impaired platelet adhesion. *Gray platelet syndrome* - This is a rare bleeding disorder characterized by a deficiency of **alpha-granules** in platelets [4]. - Platelets in this condition appear 'gray' on a blood smear due to the lack of alpha-granules that contain growth factors and adhesion proteins [4]. *von Willebrand disease* - This is primarily a deficiency or dysfunction of **von Willebrand factor (vWF)**, which is essential for **platelet adhesion** and stability of **factor VIII** [3]. - It does not directly involve a deficiency of the GPIIb-IIIa complex itself. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 668-669. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, p. 128. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 669-670. [4] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 581-582.

Question 1

Necrotizing lymphadenitis is seen in

Accepted Answer

Kikuchi-Fujimoto disease

Answer

Kimura disease

Answer

Hodgkin's lymphoma

Answer

Castleman disease

Question 2

Rosenthal's syndrome is due to deficiency of

Accepted Answer

XI

Answer

IX

Answer

VIII

Answer

XII

Question 3

Cause of ITP is

Accepted Answer

Antibody to platelets

Answer

Vasculitis

Answer

Antibody to vascular epithelium

Answer

Antibody to clotting factors

Question 4

Necrotizing lymphadenopathy is characteristically seen in:

Accepted Answer

Kikuchi disease

Answer

Non-Hodgkin's lymphoma

Answer

Castleman's disease

Answer

Kimura disease

Question 5

Fetomaternal transfusion of fetal RBCs in mother can be detected by: UPSC 08; TN 08; AIIMS 10

Accepted Answer

Betke-Kleihauer test

Answer

Electrophoresis

Answer

Indirect Coomb's test

Answer

Direct Coomb's test

Question 6

Which of the following is true about iron deficiency anemia?

Accepted Answer

Microcytic hypochromic anemia

Answer

Bone marrow iron stores are depleted before serum iron levels drop

Answer

TIBC is typically decreased in this condition

Answer

Ferritin levels are elevated in this condition

Question 7

Which of the following stains is used for reticulocyte staining?

Accepted Answer

Brilliant cresyl blue

Answer

Indigo carmine

Answer

Sudan black

Answer

Methyl violet

Question 8

ALL L3 morphology is a malignancy arising from which cell lineage –

Accepted Answer

Mature B cell

Answer

Mixed B cell & T cell

Answer

Immature T cell

Answer

Precursor B cell

Question 9

Packed red cells are commonly stored in which preservative solution?

Accepted Answer

CPDA-1 solution

Answer

AS-1 (Adsol) solution

Answer

SAG-M solution

Answer

AS-3 (Nutricel) solution

Question 10

Glycoprotein IIb-IIIa complex is deficient in

Accepted Answer

Glanzmann disease

Answer

Gray platelet syndrome

Answer

von Willebrand disease

Answer

Bernard-Soulier syndrome

Hematopathology — MCQs

Hematopathology — MCQs

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