Hematopathology Practice Questions

Q: A peripheral blood smear from a patient with a history of alcohol abuse shows hypersegmented neutrophils and oval macrocytes. Which underlying condition is most likely?

Folate Deficiency. ***Folate Deficiency*** - Hypersegmented neutrophils and **oval macrocytes** are key features indicative of **megaloblastic anemia** [1], primarily resulting from folate deficiency. - Alcohol abuse can impede folate absorption, leading to significant deficiencies and is commonly associated with these laboratory findings [2]. *Lead Poisoning* - Typically shows **basophilic stippling** of red blood cells and does not lead to hypersegmented neutrophils. - Presents with **anemia**, but the morphology is different, lacking the macrocytosis seen in folate deficiency. *Iron Deficiency Anemia* - Characterized by **microcytic hypochromic red blood cells** on blood smear, which differs from the **macrocytic** picture seen in this case. - Does not present with hypersegmented neutrophils, making it an unlikely cause here. *Thalassemia* - Presents with **microcytic anemia** and target cells, rather than macrocytic changes. - The findings of hypersegmented neutrophils and oval macrocytes are inconsistent with thalassemia's characteristic features. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 593-594. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595.

Q: A peripheral blood smear shows target cells, poikilocytosis, and basophilic stippling. Which condition is most likely associated with these findings?

Thalassemia. ***Thalassemia*** - **Target cells**, **poikilocytosis**, and **basophilic stippling** are classic findings in thalassemia due to defective hemoglobin synthesis leading to an accumulation of unassembled globin chains [1]. - The abnormal globin chains precipitate, damaging red blood cell membranes, and leading to their premature destruction and characteristic dysmorphic features [1]. *Iron Deficiency Anemia* - This condition primarily presents with **microcytic, hypochromic red cells** and often significant anisocytosis (variation in size) and poikilocytosis (variation in shape), but **target cells** and **basophilic stippling** are not typically prominent features [2]. - While red cell morphology can be abnormal, the combination described is not characteristic of uncomplicated iron deficiency. *Sideroblastic Anemia* - Characterized by **ring sideroblasts** in the bone marrow, meaning iron accumulates in the mitochondria around the nucleus of erythroid precursors. Peripheral smear findings are often dimorphic, with some microcytic hypochromic cells and some larger, normochromic cells, and occasional **Pappenheimer bodies** (siderotic granules). - While some poikilocytosis might be present, extensive **target cells** and **basophilic stippling** are not the hallmark features. *Pernicious Anemia* - This is a type of **macrocytic anemia** caused by vitamin B12 deficiency (often due to intrinsic factor deficiency). - Peripheral smear shows **macro-ovalocytes**, **hypersegmented neutrophils**, and moderate to severe anisocytosis and poikilocytosis, but not target cells or basophilic stippling. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: A 28-year-old woman presents with intermittent fever and joint pain. A biopsy of the lymph node reveals large, binucleated cells with prominent nucleoli. Which diagnostic test would confirm the probable diagnosis?

CD30 and CD15 immunohistochemistry. ***CD30 and CD15 immunohistochemistry*** - The presence of **large, binucleated cells with prominent nucleoli** (Reed-Sternberg cells) in a lymph node biopsy is highly characteristic of **Hodgkin lymphoma** [1]. - **Reed-Sternberg cells** typically express **CD30 and CD15**, and immunohistochemical staining for these markers is crucial for confirming the diagnosis of Hodgkin lymphoma [2]. *Bone marrow biopsy* - While a bone marrow biopsy may be performed for **staging** in Hodgkin lymphoma to check for marrow involvement, it is not the primary diagnostic test to confirm the initial diagnosis. - The characteristic Reed-Sternberg cells are found in the lymph nodes, not routinely in the bone marrow unless there is advanced disease [1]. *Serum lactate dehydrogenase* - **Serum LDH** can be elevated in various lymphomas and other conditions, indicating high tumor burden or cell turnover. - However, it is a **non-specific marker** and cannot confirm the specific diagnosis of Hodgkin lymphoma; it is often used for prognostication and monitoring rather than definitive diagnosis. *Peripheral blood smear* - A **peripheral blood smear** may show non-specific findings such as anemia or leukocytosis, but it does **not typically reveal Reed-Sternberg cells**. - Hodgkin lymphoma is primarily a nodal disease, and its diagnosis relies on lymph node biopsy, not examination of peripheral blood [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. 614-616. [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. 616-618.

Q: Which of the following conditions is associated with elevated leukocyte alkaline phosphatase levels?

Polycythemia vera. ***Polycythemia vera*** - **Leukocyte alkaline phosphatase (LAP)** levels are typically **elevated** in polycythemia vera and other myeloproliferative disorders [1]. [2] - This elevation is due to the increased activity of **mature neutrophils**, which contain the LAP enzyme. *Pernicious anemia* - Pernicious anemia is a **megaloblastic anemia** caused by vitamin B12 deficiency. - It is not typically associated with elevated LAP levels; rather, LAP levels are often **normal or decreased** in certain anemias. *Sickle cell anemia* - Sickle cell anemia is a **hemolytic anemia** characterized by abnormal hemoglobin. - While patients can have elevated WBC counts during crises, LAP levels are generally **normal or decreased** and not a diagnostic feature. *Plummer Vinson syndrome* - Plummer-Vinson syndrome is characterized by **iron deficiency anemia**, dysphagia due to esophageal webs, and glossitis. - LAP levels are not typically affected by this condition and are usually **normal**. **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.

Q: A 70-year-old man presents with weight loss, night sweats, and an abdominal mass. A CT scan reveals a large mesenteric mass, and a biopsy shows sheets of large lymphoid cells. What is the likely diagnosis?

Non-Hodgkin lymphoma. ***Non-Hodgkin lymphoma*** - The presence of a **large mesenteric mass** with sheets of **large lymphoid cells** on biopsy is characteristic of non-Hodgkin lymphoma, especially in older adults [1]. - Symptoms such as **weight loss** and **night sweats** align with the clinical presentation of aggressive non-Hodgkin lymphoma [1]. [2] *Multiple myeloma* - Typically presents with **bone pain**, **anemia**, and high levels of **monoclonal proteins**, not primarily with a mesenteric mass [3]. - Characterized by **punched-out** lytic lesions on imaging rather than large lymphoid masses. *Hodgkin lymphoma* - Often presents with **lymphadenopathy** and **Reed-Sternberg cells**, and less commonly with mesenteric masses [1]. - Frequently associated with **B symptoms**, but the predominant presentation here suggests a different diagnosis [2]. *Chronic lymphocytic leukemia* - Generally results in **lymphocytosis** and may involve lymph nodes but does not typically present with a large abdominal mass. - Usually presents insidiously and may show **splenomegaly**, but is not associated with sheets of large lymphoid cells seen in this case.

Q: A patient with anemia has a reticulocyte count of 6% and a hematocrit of 30%. What is the clinical significance of the corrected reticulocyte count?

4%, indicating an appropriate response to anemia.. 4%, indicating an appropriate bone marrow response - A corrected reticulocyte count of 4% shows that the bone marrow is responding adequately to the anemia, especially in the presence of an increased reticulocyte percentage relative to hematocrit. - This suggests that there is effective erythropoiesis, often seen in conditions like hemolytic anemia or recovery from blood loss. 6%, suggesting ineffective erythropoiesis - A reticulocyte count of 6% alone does not indicate ineffective erythropoiesis; rather, it points towards a reactive process by the bone marrow. - If ineffective, we would typically expect a lower reticulocyte count due to poor response despite anemia. 2%, indicating an inadequate bone marrow response - A 2% reticulocyte count suggests that the bone marrow is not responding effectively to the anemia, which contradicts the given high count of 6%. - This would be more indicative of conditions like aplasia or renal failure rather than the scenario presented. 3%, consistent with iron deficiency anemia - A count of 3% does not appropriately represent the reticulocyte response in iron deficiency anemia, which usually would show a lower reticulocyte count in severe cases. [1] - Iron deficiency typically leads to microcytic anemia with low reticulocyte production due to inadequate iron for hemoglobin synthesis. [1]

Q: Which immunohistochemical markers assist in the diagnosis of follicular lymphoma?

CD10 and BCL2. ***CD10 and BCL2*** - These markers are crucial in follicular lymphoma, with **CD10** indicating germinal center origin [2][3] and **BCL2** demonstrating the anti-apoptotic effect that contributes to neoplastic proliferation [1][2][3]. - The presence of both these markers is commonly used to characterize **follicular lymphoma**, distinguishing it from other lymphomas [1]. *CD30 and CD15* - These markers are typically associated with **Reed-Sternberg cells** in **Hodgkin lymphoma**, not follicular lymphoma. - Their presence indicates different **malignant lymphoproliferative disorders** unrelated to follicular lymphoma. *CD20 and CD23* - While CD20 is a pan B-cell marker found in many B-cell neoplasms, CD23 is more indicative of **chronic lymphocytic leukemia (CLL)** and not specific to follicular lymphoma. - They do not combine the critical features needed to diagnose follicular lymphoma effectively. *CD3 and CD7* - These are T-cell markers and do not apply to follicular lymphoma, which is a B-cell neoplasm [2][3]. - Their presence indicates T-cell malignancies rather than the **germinal center B-cell** derivation typical of follicular lymphoma [2][3]. **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. 604. [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. 602-604. [3] 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.

Q: A 5-year-old child presents with fatigue, petechiae, and hepatosplenomegaly. Laboratory results show low hemoglobin, low platelets, and high white blood cell count. The peripheral smear reveals blasts with Auer rods. What is the diagnosis?

Acute myeloid leukemia. ***Acute myeloid leukemia*** - The presence of **blasts with Auer rods** is characteristic of acute myeloid leukemia [1], which fits the laboratory findings of **low hemoglobin** and **low platelets**. - Symptoms like **fatigue**, **petechiae**, and **hepatosplenomegaly** further support this diagnosis, indicating bone marrow infiltration [1]. *Chronic myeloid leukemia* - Typically presents in older adults and is characterized by the presence of **Philadelphia chromosome** and elevated **white blood cell count** with a predominance of mature cells rather than blasts. - Fatigue and splenomegaly may occur but are not common in a child this young at the acute presentation. *Acute lymphoblastic leukemia* - Generally affects young children [2] but is characterized by **lymphoblasts** on the peripheral smear, rather than **myeloid blasts with Auer rods**. - Usually presents with a **high white blood cell count**, but symptoms differ as lymphoid infiltration is predominant. *Chronic lymphocytic leukemia* - Rarely seen in children; it typically involves an **overproduction of mature lymphocytes** and chronic lymphadenopathy rather than acute symptoms like **petechiae** or **fatigue**. - Associated with **elevated white blood cell count** with a predominance of mature lymphocytes and chronic presentations, contrasting with the acute nature of this case. **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. 621-622. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 607-608.

Q: In a patient with hemolytic anemia, which of the following laboratory findings is most likely to be elevated?

Reticulocyte count. ***Reticulocyte count*** - In **hemolytic anemia**, there's increased destruction of red blood cells, prompting the bone marrow to produce more, leading to an **elevated reticulocyte count** as it tries to compensate. - A high reticulocyte count indicates that the **bone marrow is actively responding** to the anemia. *Haptoglobin* - **Haptoglobin** binds to free hemoglobin released during red blood cell destruction. - In **hemolytic anemia**, haptoglobin levels are typically **decreased** or undetectable rather than elevated, as it is consumed in binding the excess free hemoglobin. *Indirect Bilirubin* - **Indirect bilirubin** is indeed typically elevated in hemolytic anemia due to the increased breakdown of hemoglobin and subsequent heme metabolism [1]. - However, the question asks for the *most likely* to be elevated; an **elevated reticulocyte count** is a more direct and specific indicator of increased red cell turnover due to hemolysis. *Serum Ferritin* - **Serum ferritin** reflects the body's iron stores. While chronic hemolysis can eventually lead to **iron overload** (and thus elevated ferritin) in some cases, it is not an immediate or universal finding for diagnosing acute hemolysis. - In many cases of hemolytic anemia, especially acute presentations, **ferritin levels may be normal** or even slightly low if there's concurrent iron deficiency.

Q: Which formula is essential for calculating the corrected reticulocyte count in an anemic patient?

(Reticulocyte count × Hematocrit) / 45. **(Reticulocyte count × Hematocrit) / 45** - This formula is used to calculate the **corrected reticulocyte count (CRC)**, which adjusts the observed reticulocyte percentage for the degree of **anemia**. - The value **'45' represents the normal hematocrit percentage** used as the standard for comparison [1]. * (Reticulocyte count × Hematocrit) / 50* - This formula uses an **incorrect normal hematocrit value** of 50%, which is typically higher than the average normal hematocrit for most adults. - Using an inaccurate reference hematocrit value would lead to an **overestimation of the corrected reticulocyte count**. * (Reticulocyte count × Hematocrit) / 40* - This formula uses an **incorrect normal hematocrit value** of 40%, which is generally on the lower end of the normal range or slightly below for adult males. - This could potentially **overestimate the bone marrow's reticulocyte production** in anemic individuals, depending on the patient's actual normal hematocrit level. * (Reticulocyte count × Hematocrit) / 30* - This formula uses a value of **30% as the normal hematocrit**, which is significantly lower than the accepted normal range. - Using such a low reference value would lead to a **substantial overestimation of the corrected reticulocyte count**, potentially misleading the assessment of erythropoietic activity. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 577-578.

Question 1

A peripheral blood smear from a patient with a history of alcohol abuse shows hypersegmented neutrophils and oval macrocytes. Which underlying condition is most likely?

Accepted Answer

Folate Deficiency

Answer

Iron Deficiency Anemia

Answer

Lead Poisoning

Answer

Thalassemia

Question 2

A peripheral blood smear shows target cells, poikilocytosis, and basophilic stippling. Which condition is most likely associated with these findings?

Accepted Answer

Thalassemia

Answer

Iron Deficiency Anemia

Answer

Sideroblastic Anemia

Answer

Pernicious Anemia

Question 3

A 28-year-old woman presents with intermittent fever and joint pain. A biopsy of the lymph node reveals large, binucleated cells with prominent nucleoli. Which diagnostic test would confirm the probable diagnosis?

Accepted Answer

CD30 and CD15 immunohistochemistry

Answer

Bone marrow biopsy

Answer

Serum lactate dehydrogenase

Answer

Peripheral blood smear

Question 4

Which of the following conditions is associated with elevated leukocyte alkaline phosphatase levels?

Accepted Answer

Polycythemia vera

Answer

Pernicious anemia

Answer

Sickle cell anemia

Answer

Plummer-Vinson syndrome

Question 5

A 70-year-old man presents with weight loss, night sweats, and an abdominal mass. A CT scan reveals a large mesenteric mass, and a biopsy shows sheets of large lymphoid cells. What is the likely diagnosis?

Accepted Answer

Non-Hodgkin lymphoma

Answer

Multiple myeloma

Answer

Chronic lymphocytic leukemia

Answer

Hodgkin lymphoma

Question 6

A patient with anemia has a reticulocyte count of 6% and a hematocrit of 30%. What is the clinical significance of the corrected reticulocyte count?

Accepted Answer

4%, indicating an appropriate response to anemia.

Answer

2%, indicating an inadequate response to anemia.

Answer

6%, suggesting ineffective erythropoiesis.

Answer

3%, consistent with iron deficiency anemia.

Question 7

Which immunohistochemical markers assist in the diagnosis of follicular lymphoma?

Accepted Answer

CD10 and BCL2

Answer

CD20 and CD23

Answer

CD30 and CD15

Answer

CD3 and CD7

Question 8

A 5-year-old child presents with fatigue, petechiae, and hepatosplenomegaly. Laboratory results show low hemoglobin, low platelets, and high white blood cell count. The peripheral smear reveals blasts with Auer rods. What is the diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Acute lymphoblastic leukemia

Answer

Chronic lymphocytic leukemia

Answer

Chronic myeloid leukemia

Question 9

In a patient with hemolytic anemia, which of the following laboratory findings is most likely to be elevated?

Accepted Answer

Reticulocyte count

Answer

Haptoglobin

Answer

Indirect Bilirubin

Answer

Serum Ferritin

Question 10

Which formula is essential for calculating the corrected reticulocyte count in an anemic patient?

Accepted Answer

(Reticulocyte count × Hematocrit) / 45

Answer

(Reticulocyte count × Hematocrit) / 50

Answer

(Reticulocyte count × Hematocrit) / 40

Answer

(Reticulocyte count × Hematocrit) / 30

Hematopathology — MCQs

Hematopathology — MCQs

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