Hematopathology Practice Questions

Q: Which laboratory tests are typically affected in Von Willebrand disease?

Bleeding Time (BT) and Partial Thromboplastin Time (PTT). **Explanation:** Von Willebrand Disease (vWD) is the most common inherited bleeding disorder, characterized by a deficiency or dysfunction of **Von Willebrand Factor (vWF)**. To understand the lab findings, one must remember the dual role of vWF: 1. **Platelet Adhesion:** vWF acts as a bridge between platelet GpIb receptors and subendothelial collagen [1]. A deficiency impairs primary hemostasis, leading to a **prolonged Bleeding Time (BT)**. 2. **Carrier for Factor VIII:** vWF stabilizes Factor VIII in the circulation, protecting it from rapid degradation [1]. Low levels of vWF lead to a secondary decrease in Factor VIII. Since Factor VIII is part of the intrinsic pathway, its deficiency results in a **prolonged Partial Thromboplastin Time (PTT)**. **Analysis of Options:** * **Option A (Correct):** Reflects the defect in both primary hemostasis (BT) and the intrinsic coagulation pathway (PTT). * **Option B & C (Incorrect):** Prothrombin Time (PT) measures the extrinsic and common pathways (Factors VII, X, V, II, I). These are unaffected in vWD; thus, PT is characteristically **normal**. * **Option D (Incorrect):** Clotting Time is a non-specific, insensitive test for secondary hemostasis and is not the standard diagnostic parameter for vWD. **NEET-PG High-Yield Pearls:** * **Ristocetin Cofactor Assay:** This is the "Gold Standard" diagnostic test; it measures vWF-induced platelet agglutination. * **Platelet Count:** Usually **normal** in vWD (except in Type 2B, where mild thrombocytopenia may occur). * **Treatment:** Desmopressin (DDAVP) is used as it releases stored vWF from Weibel-Palade bodies in endothelial cells. * **Inheritance:** Most types are Autosomal Dominant. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 669-670.

Q: All of the following conditions may be associated with pancytopenia and splenomegaly, except?

Aplastic Anemia. **Explanation:** The hallmark of **Aplastic Anemia** is pancytopenia resulting from bone marrow failure (hypocellular marrow). Because the pathology is a primary failure of production rather than peripheral destruction or infiltration, there is **no splenomegaly** [1]. In fact, the presence of a palpable spleen in a patient with pancytopenia should lead a clinician to look for diagnoses other than aplastic anemia. **Analysis of Options:** * **Hairy Cell Leukemia (B):** This is a classic cause of "massive splenomegaly" and pancytopenia. The pancytopenia occurs due to bone marrow infiltration and splenic sequestration. * **Myelofibrosis (C):** In the fibrotic stage, the marrow fails (pancytopenia), leading to compensatory **Extramedullary Hematopoiesis (EMH)**. This results in significant hepatosplenomegaly. * **Hypersplenism (D):** This is a functional state where an enlarged spleen (due to portal hypertension, storage disorders, etc.) excessively sequesters and destroys circulating blood cells, leading to pancytopenia [2]. **NEET-PG High-Yield Pearls:** 1. **Rule of Thumb:** If pancytopenia is present **without** splenomegaly, think Aplastic Anemia, PNH, or Vitamin B12 deficiency. 2. **Rule of Thumb:** If pancytopenia is present **with** splenomegaly, think Hairy Cell Leukemia, Myelofibrosis, Kala-azar, or Gaucher’s disease. 3. **Bone Marrow Finding:** In Aplastic Anemia, the marrow is replaced by fat cells ("Dry tap" is not common here; rather, a "fatty marrow" is seen on biopsy) [1]. 4. **Hairy Cell Leukemia** is uniquely associated with "Dry tap" on aspiration and TRAP (Tartrate-Resistant Acid Phosphatase) positivity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 662-663. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 604-605.

Question 1

A 70-year-old male has a pathologic fracture of the femur. X-rays show a lytic lesion with a circumscribed, punched-out appearance. Curettage from the fracture site is most likely to show which of the following?

Accepted Answer

Sheets of atypical plasma cells

Answer

Diminished and thinned trabecular bone

Answer

Metastatic prostatic adenocarcinoma

Answer

Malignant cells forming osteoid bone

Question 2

Mycosis cells are altered:

Accepted Answer

T Lymphocytes

Answer

Monocytes

Answer

B lymphocytes

Answer

Eosinophils

Question 3

Which of the following conditions is associated with an increased Erythrocyte Sedimentation Rate (ESR)?

Accepted Answer

Multiple myeloma

Answer

Sickle cell anemia

Answer

Polycythemia vera

Answer

Thalassemia

Question 4

Which laboratory tests are typically affected in Von Willebrand disease?

Accepted Answer

Bleeding Time (BT) and Partial Thromboplastin Time (PTT)

Answer

Prothrombin Time (PT) and Partial Thromboplastin Time (PTT)

Answer

Prothrombin Time (PT)

Answer

Clotting Time (CT)

Question 5

Which metabolic abnormality is seen in multiple myeloma?

Accepted Answer

Hypercalcemia

Answer

Hyponatremia

Answer

Hypokalemia

Answer

Hyperphosphatemia

Question 6

Which of the following statements are true about blood transfusion reactions?

Accepted Answer

Renal blood flow is decreased

Answer

Complement mediated severe hemolysis

Answer

Transfusion should not be stopped

Answer

Death is not seen

Question 7

All of the following conditions may be associated with pancytopenia and splenomegaly, except?

Accepted Answer

Aplastic Anemia

Answer

Hairy Cell Leukemia

Answer

Myelofibrosis

Answer

Hypersplenism

Question 8

Which of the following are true about aplastic anemia?

Accepted Answer

Nucleated RBCs in peripheral blood

Answer

Splenomegaly

Answer

Reticulocytopenia

Answer

Thrombocytopenia and Neutropenia

Question 9

Howell-Jolly bodies are seen in which of the following conditions?

Accepted Answer

Hemolytic anemia

Answer

Iron deficiency anemia

Answer

Polycythemia vera

Answer

Multiple myeloma

Question 10

What test helps differentiate between leukemia and leukemoid reaction?

Accepted Answer

Leukocyte alkaline phosphatase

Answer

Presence of immature cells

Answer

Total leukocyte count

Answer

Erythrocyte sedimentation rate

Hematopathology — MCQs

Hematopathology — MCQs

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