Hematopathology Practice Questions

Q: Commonest malignancy that can cause splenic metastasis is which of the following?

Ca. Melanoma. ***Correct: Ca. Melanoma*** - **Melanoma** is the **most common primary malignancy** to metastasize to the spleen in autopsy series [1] - Despite splenic metastases being rare overall (2-9% of cancer patients), melanoma has the **highest propensity** for splenic involvement due to its aggressive hematogenous spread pattern [1] - Melanoma can metastasize to virtually any organ, and the spleen is a recognized site with melanoma being the leading primary source - Other common primaries include breast, lung, ovarian, and colorectal cancers *Incorrect: Ca. Pancreas* - While pancreatic cancer can involve the spleen, this typically occurs through **direct extension** due to anatomical proximity rather than true hematogenous metastasis - Pancreatic cancer more commonly spreads to liver, peritoneum, and regional lymph nodes - It is not the most common source of splenic metastases overall *Incorrect: Ca. Stomach* - Gastric cancer can rarely metastasize to the spleen, but this is uncommon - More typical sites of gastric cancer metastasis include liver, peritoneum, lungs, and lymph nodes - Splenic involvement is much less frequent than with melanoma *Incorrect: Ca. Cervix* - Cervical cancer typically spreads by **local extension** and via lymphatics to pelvic and para-aortic nodes - It may involve bladder, rectum, and vagina through direct spread - **Splenic metastases** from cervical cancer are extremely rare and not a characteristic pattern of spread **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Disorders Involving Inflammatory And Haemopoietic Cells, pp. 650-651.

Q: Heinz bodies are removed by?

Macrophages. ***Macrophages*** - Macrophages, particularly those in the **spleen**, are responsible for pitting out Heinz bodies from red blood cells. - This process is part of the **extravascular hemolysis** that occurs when red blood cells containing Heinz bodies are prematurely destroyed. *Lymphocytes* - Lymphocytes are primary cells of the **adaptive immune system**, involved in recognizing and targeting specific pathogens or abnormal cells. - They do not play a role in the removal of intracellular inclusions like Heinz bodies from red blood cells. *Neutrophils* - Neutrophils are a type of **phagocyte** and a crucial component of the **innate immune system**, primarily involved in fighting bacterial and fungal infections. - Their function is mainly in acute inflammation and phagocytosing microbes, not in the removal of inclusions from red blood cells. *Fibroblasts* - Fibroblasts are responsible for producing the **extracellular matrix** and **collagen**, playing a critical role in wound healing and tissue repair. - They are not immune cells and are not involved in the removal of cellular debris or inclusions like Heinz bodies.

Q: Maximum life of transfused RBCs is

80-100 days. ***80-100 days*** - The maximum lifespan of **transfused red blood cells (RBCs)** is reduced compared to naturally occurring RBCs in vivo. - This is due to storage conditions and the age of the donated blood, leading to a shorter survival time post-transfusion. *110-120 days* - This range typically represents the **normal lifespan of red blood cells in the human body** *in vivo*, not the effective lifespan of transfused units. - Transfused RBCs undergo various changes during storage (storage lesion) that reduce their post-transfusion survival. *60-80 days* - While closer to the actual range for transfused RBCs, this is generally considered a slightly **underestimated maximum lifespan**. - The survival of transfused RBCs can vary, but good quality units usually last longer than 80 days. *50-60 days* - This range is typically too low for the maximum lifespan of transfused RBCs, indicating either **poor quality blood products** or significantly **prolonged storage times**. - Most transfused RBCs, when properly stored and handled, will survive for a longer duration post-transfusion.

Q: Which condition is most commonly associated with basophilic leukocytosis?

Chronic Myeloid Leukemia (CML). ***Chronic Myeloid Leukemia (CML)*** - **Basophilic leukocytosis** is a characteristic feature of **CML**, resulting from the clonal expansion of myeloid stem cells. - The presence of **immature granulocytes**, including basophils, is key to diagnosing CML, particularly in the chronic phase. *Acute Myeloid Leukemia (AML)* - AML is characterized by an excessive proliferation of **myeloblasts** (immature myeloid cells) in the bone marrow and peripheral blood, not mature basophils. - While other myeloid lineages can be affected, basophilic leukocytosis is not a defining or common feature. *Acute Lymphoblastic Leukemia (ALL)* - ALL involves the uncontrolled proliferation of **lymphoblasts** (immature lymphoid cells). - This condition is specifically associated with the lymphoid lineage and does not typically cause an increase in myeloid cells like basophils. *Chronic Lymphocytic Leukemia (CLL)* - CLL is characterized by the accumulation of **mature, but dysfunctional, B lymphocytes**. - It involves the lymphoid lineage and does not lead to basophilic leukocytosis, which is a feature of myeloid disorders.

Q: Which factor is primarily found in cryoprecipitate?

Factor VIII. ***Factor VIII*** - Cryoprecipitate is enriched with **Factor VIII**, essential for blood coagulation and hemophilia treatment [1]. - It also contains **fibrinogen**, **Factor XIII**, and von Willebrand factor, crucial for stable clot formation [1]. *Factor II* - Factor II, also known as **prothrombin**, is mainly found in **plasma**, not concentrated in cryoprecipitate. - It is not specifically extracted through cryoprecipitation, which focuses on fibrinogen and other factors. *Factor V* - Factor V is generally present in **plasma**, but not in significant amounts in cryoprecipitate. - It plays a role in the coagulation cascade but is not a primary component of cryoprecipitate. *Factor IX* - Factor IX is mainly associated with the **intrinsic pathway** of coagulation and is part of plasma, not concentrated in cryoprecipitate. - While it is vital for hemophilia B, it does not form part of the cryoprecipitate's key components. **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: Which of the following statements about thrombotic thrombocytopenic purpura is false?

Grossly abnormal coagulation tests. ***Grossly abnormal coagulation tests*** - In thrombotic thrombocytopenic purpura (TTP), coagulation tests typically remain **normal**, which is a distinguishing factor from other conditions like disseminated intravascular coagulation (DIC) [1]. - The primary pathology in TTP is due to a deficiency in **ADAMTS13**, leading to the formation of large von Willebrand factor multimers without significant **coagulation abnormalities** [2]. *Normal complement level* - TTP is not associated with **complement system abnormalities**; often, complement levels are normal, unlike conditions such as **atypical hemolytic uremic syndrome**. - Increased activation or consumption of complement is not a typical feature in TTP, making this statement false. *Micro angiopathic hemolytic anemia* - Microangiopathic hemolytic anemia is a hallmark of TTP, resulting from the **shearing of erythrocytes** in the small vasculature due to thrombi formation [1,2]. - The presence of **schistocytes** on a peripheral blood smear is commonly observed in this condition, indicating this statement is true. *Thrombocytopenia* - TTP is characterized by severe **thrombocytopenia** resulting from the consumption of platelets during the formation of microthrombi [1,2]. - This condition often leads to **purpura** and increased bleeding tendencies due to low platelet counts, confirming this option is true. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 667-668. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Kidney, pp. 947-948.

Q: Flow cytometry is primarily used for analysis of which of the following cell types?

Lymphocytes. ***Lymphocytes*** - Flow cytometry is excellently suited for **lymphocyte analysis** due to their distinct surface markers (CD antigens) that can be labeled with fluorescent antibodies. - It allows for the **identification and quantification of various lymphocyte subsets** (e.g., T cells, B cells, NK cells), crucial in diagnosing immunodeficiencies, autoimmune diseases, and hematologic malignancies. *Erythrocytes* - While flow cytometry can detect erythrocytes, their primary role is oxygen transport, and they **lack cell surface markers** commonly analyzed by flow cytometry for classification. - **Complete blood count (CBC)** is the standard method for erythrocyte quantification and morphological analysis. *Platelets* - Flow cytometry can be used to study platelet activation and surface markers, but it's not their **primary or routine analytical tool** for mere count or general assessment. - **Automated hematology analyzers** are routinely used for platelet counts and basic morphology. *Basophil* - Basophils are a type of granulocyte and can be identified by flow cytometry, but they are a **very small percentage of circulating leukocytes**, making them less commonly the *primary* target of a typical flow cytometry panel focused on overall leukocyte populations. - While they can be analyzed, lymphocytes offer a much **broader range of clinical utility** due to their diverse subpopulations and roles in immunity and disease.

Q: In which condition is thymic hyperplasia commonly observed?

Myasthenia gravis. ***Myasthenia gravis*** - Thymic hyperplasia is commonly associated with **myasthenia gravis**, particularly in **thymic enlargement** cases [1]. - This autoimmune condition often results in **autoantibody production** against acetylcholine receptors due to changes in the thymus [1]. *Scleroderma* - This condition primarily involves **skin thickening** and is characterized by **autoimmune fibrosis**, with no direct association with thymic hyperplasia. - Thymic changes are not a common finding or related to the pathophysiology of scleroderma. *Thymoma* - While thymoma can cause **thymic enlargement**, it is characterized more by **tumor formation** rather than hyperplasia. - Thymoma is a tumor of the thymus itself, which can be associated with myasthenia gravis, but does not represent **hyperplastic changes**. *Thymic lymphoma* - This is a malignancy of the thymus that presents as a mass rather than **hyperplastic tissue**. - Thymic lymphoma typically results in **destructive processes** rather than dietary overgrowth or hyperplasia of thymic tissue. **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. 634.

Q: Which of the following is NOT a feature of G-6PD deficiency?

Hereditary spherocytosis. ***Membrane defect*** - **G-6PD deficiency** is primarily characterized by a deficiency in the enzyme glucose-6-phosphate dehydrogenase, rather than a membrane defect [1]. - It leads to **oxidative stress** rather than issues with red blood cell membranes [1]. *Bite cells* - Bite cells are actually a result of **oxidative damage** due to G-6PD deficiency and occur during hemolytic episodes [2]. - They are formed when **macrophages** remove denatured hemoglobin from erythrocytes. *Intravascular hemolysis* - This condition often occurs in G-6PD deficiency due to oxidative stress leading to the destruction of red blood cells, particularly during crises [2]. - The hemolysis is often **acute** and triggered by infections, certain drugs, or food (like fava beans) [3]. *Oxidative stress* - Oxidative stress is a key pathological mechanism in G-6PD deficiency, causing vulnerability of red blood cells to hemolysis [1]. - It leads to **increased susceptibility** to infections and hemolytic episodes upon exposure to oxidant drugs or agent [2].

Q: Which of the following is a feature not typically associated with Hereditary Spherocytosis?

Direct Coombs Positive. ***Direct Coomb's Positive*** - In Hereditary Spherocytosis, the **Coomb's test** is typically **negative**, indicating that hemolysis is not due to autoimmune factors. - Presence of **spherocytes** on the blood smear and increased fragility are hallmark findings, not antibodies against red cells [1]. *Splenomegaly* - **Splenomegaly** is common in Hereditary Spherocytosis as the spleen actively removes abnormal spherocytes from circulation [1]. - It can lead to **hypersplenism**, with resultant anemia and thrombocytopenia. *Increased Osmotic Fragility* - Increased osmotic fragility is a key feature of Hereditary Spherocytosis, as red blood cells are less able to withstand hypotonic solutions [1]. - This results from a defect in the red cell membrane, causing spherocyte shape and fragility. *Gall stones* - Patients may develop **gallstones** due to increased bilirubin from the breakdown of spherocytes, leading to **bilirubin stones** [1]. - Gallstones are a common complication due to chronic hemolysis. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 597-598.

Question 1

Commonest malignancy that can cause splenic metastasis is which of the following?

Accepted Answer

Ca. Melanoma

Answer

Ca. Stomach

Answer

Ca. Cervix

Answer

Ca. Pancreas

Question 2

Heinz bodies are removed by?

Accepted Answer

Macrophages

Answer

Lymphocytes

Answer

Neutrophils

Answer

Fibroblasts

Question 3

Maximum life of transfused RBCs is

Accepted Answer

80-100 days

Answer

60-80 days

Answer

50-60 days

Answer

110-120 days

Question 4

Which condition is most commonly associated with basophilic leukocytosis?

Accepted Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Myeloid Leukemia (AML)

Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

Chronic Lymphocytic Leukemia (CLL)

Question 5

Which factor is primarily found in cryoprecipitate?

Accepted Answer

Factor VIII

Answer

Factor II

Answer

Factor V

Answer

Factor IX

Question 6

Which of the following statements about thrombotic thrombocytopenic purpura is false?

Accepted Answer

Grossly abnormal coagulation tests

Answer

Microangiopathic hemolytic anemia

Answer

Thrombocytopenia

Answer

Normal complement level

Question 7

Flow cytometry is primarily used for analysis of which of the following cell types?

Accepted Answer

Lymphocytes

Answer

Platelets

Answer

Erythrocytes

Answer

Basophils

Question 8

In which condition is thymic hyperplasia commonly observed?

Accepted Answer

Myasthenia gravis

Answer

Thymic carcinoma

Answer

Lambert-Eaton myasthenic syndrome

Answer

Thymic neoplasm

Question 9

Which of the following is NOT a feature of G-6PD deficiency?

Accepted Answer

Hereditary spherocytosis

Answer

Oxidative stress

Answer

Bite cells

Answer

Intravascular hemolysis

Question 10

Which of the following is a feature not typically associated with Hereditary Spherocytosis?

Accepted Answer

Direct Coombs Positive

Answer

Gall stones

Answer

Splenomegaly

Answer

Increased Osmotic Fragility

Hematopathology — MCQs

Hematopathology — MCQs

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