Hematopathology Practice Questions

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.

Q: EBV positivity is higher in which type of Hodgkin lymphoma?

Mixed cellularity. **Explanation:** The association between **Epstein-Barr Virus (EBV)** and Hodgkin Lymphoma (HL) varies significantly across histological subtypes. EBV is found in the Reed-Sternberg (RS) cells, where it expresses LMP-1 (Latent Membrane Protein-1), mimicking CD40 signaling to promote B-cell survival. * **Mixed Cellularity (MC):** This subtype shows the strongest association with EBV in classical HL, with **75% to 85%** of cases being EBV-positive. It typically affects older patients or those in developing countries and is characterized by a polymorphic inflammatory infiltrate (eosinophils, plasma cells, histiocytes) [1]. * **Lymphocyte Depleted (LD):** This also has a very high association with EBV (approx. 90%), but it is the rarest subtype. In the context of standard NEET-PG questions, **Mixed Cellularity** is the classic answer for "highest association" among the common subtypes [1]. * **Nodular Sclerosis (NS):** This is the most common subtype overall (especially in young females). It has a relatively low EBV association (approx. 10-40%) [1]. * **Lymphocyte Rich (LR):** This subtype has an intermediate association (approx. 40%) and carries a very good prognosis [1]. * **Nodular Lymphocyte Predominant HL (NLPHL):** This is a non-classical HL and is almost **always EBV-negative**. **High-Yield Pearls for NEET-PG:** 1. **Most common subtype:** Nodular Sclerosis (characterized by Lacunar cells and collagen bands) [1]. 2. **Best prognosis:** Lymphocyte Rich (among classical) or NLPHL. 3. **Worst prognosis:** Lymphocyte Depleted. 4. **RS Cell Markers:** Classical HL is **CD15+, CD30+, and CD45–**. NLPHL is **CD20+ and CD45+** (Popcorn cells). **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. 616-618.

Q: Haemophilia is a genetic disorder of coagulation. It is transmitted as

X-linked recessive. **Explanation:** **Haemophilia (A and B)** is a classic example of an **X-linked recessive** inheritance pattern [1]. 1. **Why X-linked Recessive is correct:** The genes for Factor VIII (Haemophilia A) and Factor IX (Haemophilia B) are located on the **X chromosome**. Because it is recessive, males (XY) are primarily affected as they possess only one X chromosome (hemizygous) [1]. Females (XX) are typically asymptomatic carriers because their second X chromosome usually carries a functional gene that provides sufficient clotting factor levels. 2. **Why other options are incorrect:** * **X-linked dormant:** "Dormant" is not a standard genetic term for inheritance. The correct term for a trait that is expressed only when no dominant allele is present is "recessive." * **Y-linked:** Y-linked (holandric) traits are passed only from father to son [1]. Haemophilia genes are not located on the Y chromosome. * **Autosomal recessive:** This would imply the gene is on a non-sex chromosome (1-22). While rare bleeding disorders like Factor X deficiency are autosomal, Haemophilia A and B are strictly sex-linked. **High-Yield Clinical Pearls for NEET-PG:** * **Lyonization:** Female carriers may occasionally show bleeding tendencies due to "unfavorable lyonization" (random inactivation of the X chromosome carrying the normal gene) [2]. * **Inheritance Pattern:** An affected father will pass the gene to **all** his daughters (carriers) but **none** of his sons [1]. * **Clinical Presentation:** Characterized by **hemarthrosis** (bleeding into joints) and delayed bleeding after trauma. * **Laboratory:** Prolonged **aPTT** with a normal PT and normal bleeding time. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, p. 151. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 670-671.

Q: FLT3-TKD gene is located at?

13q12. ### Explanation **Correct Option: A (13q12)** The **FLT3** (*Fms-like tyrosine kinase 3*) gene is located on the long arm of **chromosome 13 (13q12)**. It encodes a Class III receptor tyrosine kinase essential for the proliferation and survival of hematopoietic stem cells [1]. In Acute Myeloid Leukemia (AML), FLT3 mutations are highly significant: 1. **FLT3-ITD (Internal Tandem Duplication):** Most common; associated with a **poor prognosis**, high relapse rates, and high leukocytosis [1]. 2. **FLT3-TKD (Tyrosine Kinase Domain):** Point mutations (usually at codon D835) that lead to constitutive activation of the kinase [1]. **Analysis of Incorrect Options:** * **B. 11q23:** This is the locus for the **KMT2A (formerly MLL)** gene. Rearrangements here are common in infant leukemias and therapy-related AML (topoisomerase II inhibitor-induced). * **C. 11p13:** This is the locus for the **WT1** (Wilms Tumor 1) gene. Mutations are seen in Wilms tumor and a subset of AML cases. * **D. 4q24:** This is the locus for the **TET2** gene, frequently mutated in myelodysplastic syndromes (MDS) and AML, affecting DNA methylation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common mutation in AML:** FLT3 (found in ~30% of cases). * **Prognostic Significance:** FLT3-ITD mutations confer a worse prognosis compared to FLT3-TKD. * **Targeted Therapy:** Midostaurin and Gilteritinib are FLT3 inhibitors used in treatment. * **NPM1 vs. FLT3:** In the absence of FLT3-ITD, an *NPM1* mutation signifies a favorable prognosis in cytogenetically normal AML. **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.

Question 1

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 2

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

Question 3

Bone marrow biopsy is useful in the diagnosis of which of the following conditions?

Accepted Answer

Aleukemic Leukemia

Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

Hodgkin's disease

Question 4

Bite cells are characteristic of which of the following conditions?

Accepted Answer

G6PD deficiency

Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

Sideroblastic anemia

Question 5

EBV positivity is higher in which type of Hodgkin lymphoma?

Accepted Answer

Mixed cellularity

Answer

Nodular sclerosis

Answer

Lymphocyte depleted

Answer

Lymphocyte rich

Question 6

Primary hemostasis is disturbed in which of the following conditions?

Accepted Answer

Platelet disorder

Answer

Lupus anticoagulant

Answer

Hemophilia

Answer

Liver disease

Question 7

Haemophilia is a genetic disorder of coagulation. It is transmitted as

Accepted Answer

X-linked recessive

Answer

X-linked dormant

Answer

Y-linked dormant

Answer

Autosomal recessive

Question 8

FLT3-TKD gene is located at?

Accepted Answer

13q12

Answer

11q23

Answer

11p13

Answer

4q24

Question 9

Spherocytosis of RBC is a common feature in which of the following conditions?

Accepted Answer

G6PD deficiency

Answer

Sickle cell anemia

Answer

CML

Answer

All of the above

Question 10

Which of the following is NOT a blood component product?

Accepted Answer

None of the above

Answer

Whole blood

Answer

Platelets

Answer

Lymphoma

Hematopathology — MCQs

Hematopathology — MCQs

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