Hematopathology Practice Questions

Q: The removal of malarial parasites from the red blood cells is called:

Pitting. ***Pitting*** - **Pitting** is the process by which the spleen removes intraerythrocytic inclusions, such as malarial parasites, Howell-Jolly bodies, or Heinz bodies, from red blood cells while leaving the cell intact. - This function is critical in controlling **parasitemia** in malaria, as the spleen filters infected red blood cells and extracts the parasites, often resulting in uninfected, but slightly deformed, red blood cells returning to circulation. *Binding* - **Binding** refers to the adhesion of malarial parasites to red blood cells or endothelial cells, a process involved in parasite invasion or sequestration. - It does not describe the specific removal of the parasite from an already infected red blood cell. *Culling* - **Culling** is the process by which the spleen removes and destroys senescent (old) or damaged red blood cells from circulation. - While related to red blood cell removal, it specifically targets entire dysfunctional cells and doesn't describe the removal of an inclusion from an otherwise viable red blood cell. *Phagocytosis* - **Phagocytosis** is the process by which phagocytic cells (e.g., macrophages) engulf and digest foreign particles, microorganisms, or cellular debris. - While phagocytosis is crucial in clearing infected whole red blood cells, it is distinct from "pitting," where the parasite is "pitted out" of an intact red blood cell.

Q: In infectious mononucleosis, which cell type shows the most significant pathological changes?

T-cells. ***Correct: T-cells*** - In response to **Epstein-Barr virus (EBV)** infection of B-cells, there is a massive proliferation of **CD8+ cytotoxic T-lymphocytes** which are responsible for controlling the infection and mediating many of the symptoms. - These activated T-cells, known as **atypical lymphocytes** or **Downey cells**, are the characteristic pathological finding in peripheral blood smears of patients with infectious mononucleosis. - The **lymphocytosis with atypical lymphocytes** (>10% of total WBCs) is the hallmark laboratory finding. *Incorrect: B-cells* - **EBV directly infects B-cells**, leading to their proliferation, but the most significant pathological changes observed in the blood smear are due to the host's immune response. - While B-cells are the primary target of EBV, the hallmark feature of infectious mononucleosis on a peripheral blood smear is the presence of reactive T-cells, not the infected B-cells themselves. *Incorrect: Macrophages* - Macrophages play a role in clearing cellular debris and presenting antigens during an infection, but they do not show the most significant **pathological changes** or proliferative response characteristic of infectious mononucleosis. - They are generally not the predominant cell type exhibiting **atypical morphology** in the peripheral blood during this condition. *Incorrect: NK cells* - **Natural killer (NK) cells** are part of the innate immune response and contribute to controlling viral infections, including EBV. - However, they do not undergo the distinct and extensive **morphological changes** and proliferation seen in T-cells during infectious mononucleosis.

Q: 24 years old female patient presents with acute blood loss secondary to bilateral fracture femur. Reticulocytosis is evident on peripheral smear examination. Patient's anemia can be categorized into which of the following types?

Normocytic normochromic. ***Normocytic normochromic*** - **Acute blood loss** results in a loss of whole blood, meaning that the remaining red blood cells are still of normal size and hemoglobin content, hence **normocytic normochromic** [1]. - The presence of **reticulocytosis** is a physiological response, indicating that the bone marrow is actively producing new red blood cells to compensate for the acute loss, which also tend to be of normal size initially [1]. *Microcytic hypochromic* - This type of anemia is typically seen in conditions involving **chronic blood loss** or **iron deficiency**, where there is insufficient iron to produce normal hemoglobin, leading to small, pale red blood cells [3]. - While blood loss is present, it is acute, and there hasn't been sufficient time for iron stores to be depleted to this extent [2]. *Microcytic normochromic* - This is not a common classification of anemia; red blood cells that are **microcytic** (small) are almost always **hypochromic** (pale) due to reduced hemoglobin content. - This option does not accurately represent the physiological response to acute blood loss. *Normocytic Hypochromic* - This is also not a common classification; **normocytic** (normal size) red blood cells usually have normal hemoglobin content and thus appear **normochromic** [2]. - Hypochromia typically accompanies microcytosis due to the same underlying issues of impaired hemoglobin synthesis.

Q: All of the following are seen in polycythemia rubra vera except :

Decreased LAP Score. ***Decreased LAP Score*** - **LAP (Leukocyte Alkaline Phosphatase) score** is typically **increased or normal** in polycythemia vera. - A decreased LAP score is characteristic of **chronic myeloid leukemia (CML)**, which must be differentiated from polycythemia vera [2]. *Increased platelets* - **Thrombocytosis** (increased platelets) is a common feature of **polycythemia vera**, often contributing to vascular complications [1], [2]. - The unregulated proliferation of all myeloid cell lines, including megakaryocytes, leads to this increase [1], [3]. *Increased Vit B12 binding capacity (>9000 micromols/dL)* - Polycythemia vera often leads to **increased vitamin B12 levels** and **binding capacity** due to increased production of **transcobalamin I** by proliferating granulocytes. - While not a direct diagnostic criterion, it is a frequent finding supportive of the diagnosis. *Leucocytosis* - **Leukocytosis** (increased white blood cell count), particularly granulocytosis, is a common feature of polycythemia vera [1], [2]. - It results from the **clonal proliferation** of myeloid stem cells, leading to an overproduction of all myeloid lineage cells [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 614-615. [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. 626-627. [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, pp. 627-628.

Q: Which of the following is NOT a genetic risk factor for leukemia?

Hemophilia A. ***Hemophilia A*** - Hemophilia A is an **X-linked recessive bleeding disorder** caused by deficiency of **Factor VIII** (clotting factor) [1]. - While it is a genetic condition, it is **NOT associated with increased risk of leukemia**. - Hemophilia A affects the coagulation cascade and causes bleeding tendency, but does not involve genomic instability or DNA repair defects that predispose to malignancy [1], [2]. *Incorrect: Ataxia telangiectasia* - This is an **autosomal recessive disorder** caused by mutations in the **ATM gene**, which is involved in DNA repair. - Individuals with ataxia telangiectasia have an increased risk of developing **acute lymphoblastic leukemia (ALL)** and lymphomas due to impaired DNA repair mechanisms and chromosomal instability. *Incorrect: Down syndrome* - Also known as **Trisomy 21**, this chromosomal disorder is the most common genetic condition associated with an increased risk of leukemia. - Individuals with Down syndrome have a **10- to 20-fold higher risk** of developing **acute myeloid leukemia (AML)** and **acute lymphoblastic leukemia (ALL)**, particularly a unique form called **transient myeloproliferative disorder (TMD)** in infancy, which can progress to AML. *Incorrect: None of the options* - This is incorrect because **Hemophilia A** is indeed NOT a genetic risk factor for leukemia, making it the correct answer to this "NOT" question. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 670-671. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 622-623.

Q: Hemolysis is predominantly intravascular in which of the following conditions?

Paroxysmal nocturnal hemoglobinuria. ***Paroxysmal nocturnal hemoglobinuria*** - **PNH** is characterized by a defect in the **PIG-A gene**, leading to a deficiency of **GPI-anchored proteins** like CD55 and CD59 on red blood cells [1]. - This deficiency makes the red blood cells susceptible to complement-mediated lysis, predominantly occurring **intravascularly** [1]. *Warm autoimmune hemolytic anemia* - This condition involves **IgG autoantibodies** binding to red blood cells, which are then primarily removed by **macrophages in the spleen** and liver (extravascular hemolysis) [2]. - The presence of **spherocytes** and a positive direct **antiglobulin test (DAT)** are characteristic [2]. *Cold autoimmune hemolytic anemia* - Involves **IgM autoantibodies** that bind to red blood cells at colder temperatures, often causing agglutination in the peripheral circulation. - While some complement activation and lysis can occur intravascularly, the primary mechanism involves **macrophages in the liver** clearing antibody-coated red cells (extravascular), or red cell destruction in the cooler acral areas. *Spherocytosis* - This is a condition of abnormal red blood cell shape due to defects in **cytoskeletal proteins** (e.g., spectrin, ankyrin), making them less deformable. - These rigid spherocytes are primarily trapped and destroyed by the **phagocytic cells in the spleen**, indicating an **extravascular hemolytic process** [2]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 650-651. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 602-603.

Question 1

The removal of malarial parasites from the red blood cells is called:

Accepted Answer

Pitting

Answer

Binding

Answer

Culling

Answer

Phagocytosis

Question 2

In infectious mononucleosis, which cell type shows the most significant pathological changes?

Accepted Answer

T-cells

Answer

B-cells

Answer

Macrophages

Answer

NK cells

Question 3

24 years old female patient presents with acute blood loss secondary to bilateral fracture femur. Reticulocytosis is evident on peripheral smear examination. Patient's anemia can be categorized into which of the following types?

Accepted Answer

Normocytic normochromic

Answer

Microcytic hypochromic

Answer

Microcytic normochromic

Answer

Normocytic Hypochromic

Question 4

Which among the following statements is wrong?

Accepted Answer

M components are detected in chronic myeloid leukemia.

Answer

In 20% of myelomas, only light chains are produced.

Answer

Light chains are synthesized in slight excess normally in plasma cells.

Answer

Qualitative assessment of M component can be done by electrophoresis.

Question 5

All of the following are seen in polycythemia rubra vera except :

Accepted Answer

Decreased LAP Score

Answer

Increased platelets

Answer

Increased Vit B12 binding capacity (>9000 micromols/dL)

Answer

Leucocytosis

Question 6

Which of the following is NOT a genetic risk factor for leukemia?

Accepted Answer

Hemophilia A

Answer

Ataxia telangiectasia

Answer

Down's syndrome

Answer

None of the options

Question 7

Necrotizing granulomatous lymphadenopathy is caused by -

Accepted Answer

Atypical mycobacterial infection

Answer

Cat Scratch Disease (Bartonella henselae)

Answer

Sarcoidosis

Answer

Kikuchi disease

Question 8

Bleeding time assesses

Accepted Answer

Function of platelets

Answer

Fibrinogen Level

Answer

Extrinsic clotting pathway

Answer

Intrinsic clotting pathway

Question 9

Which of the following is positive in Follicular lymphoma?

Accepted Answer

Bcl-2 protein

Answer

Cyclin D1 (Bcl-1)

Answer

Bcl-10 signaling protein

Answer

Bcl-6 transcription factor

Question 10

Hemolysis is predominantly intravascular in which of the following conditions?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Warm autoimmune hemolytic anemia

Answer

Cold autoimmune hemolytic anemia

Answer

Spherocytosis

Hematopathology — MCQs

Hematopathology — MCQs

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