Hematopathology Practice Questions

Q: The most common subtype of Non-Hodgkin's lymphoma in India is:

Diffuse large B cell lymphoma. ***Diffuse large B cell lymphoma*** - It is the most common subtype of **Non-Hodgkin's lymphoma** observed in India, reflecting a higher prevalence in the population. - Characterized by **aggressive clinical behavior** [1] and typically presents as a rapidly enlarging mass, often involving lymph nodes or extranodal sites. *Burkitt's lymphoma* - This subtype is known for its **high proliferation rate** and is more common in specific demographics, such as children and immunocompromised individuals. - It typically presents with **jaw lesions** or abdominal masses, which is not typical in the broader Indian population. *Diffuse small cell lymphocytic lymphoma* - More accurately classified as **chronic lymphocytic leukemia** (CLL), it is not the most common subtype of Non-Hodgkin's lymphoma. - Characterized by a **milder clinical course** and presents with lymphocytosis in peripheral blood, lacking aggressive features. *Follicular lymphoma* - This is usually a **low-grade lymphoma** associated with **indolent behavior** and may not be the most commonly diagnosed subtype in India. - It typically involves multiple lymph nodes and is characterized by **nodular patterns on histology**, making it less prevalent than diffuse large B cell lymphoma. Follicular lymphoma is rare in Asian populations [2]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 563-564. [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.

Q: ABO isoantibodies are of which class?

IgM. ***IgM*** - Naturally occurring **ABO isoantibodies** are predominantly of the **IgM class**. - These **pentameric antibodies** are highly effective at causing **agglutination** of incompatible red blood cells, which is crucial in transfusion reactions [1]. *IgG* - While IgG antibodies can be formed against ABO antigens (e.g., in hemolytic disease of the newborn), the **naturally occurring isoantibodies** are primarily IgM. - IgG antibodies are **monomeric** and can cross the **placenta**, which is a key difference from the primary IgM ABO antibodies. *IgD* - **IgD** antibodies are primarily found on the surface of **B cells** and play a role in B cell activation. - They are **not a primary mediator** of ABO isoantibody response or red blood cell agglutination. *IgA* - **IgA** antibodies are predominantly found in **mucosal secretions** and play a role in mucosal immunity. - While some IgA may be present, it is **not the predominant class** for naturally occurring ABO isoantibodies involved in transfusion reactions. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. (Basic Pathology) introduces the student to key general principles of pathology, both as a medical science and as a clinical activity with a vital role in patient care. Part 2 (Disease Mechanisms) provides fundamental knowledge about the cellular and molecular processes involved in diseases, providing the rationale for their treatment. Part 3 (Systematic Pathology) deals in detail with specific diseases, with emphasis on the clinically important aspects., pp. 154-155.

Q: Which of the following myeloid leukemias is not classified as a myeloproliferative neoplasm?

Acute myeloid leukemia. ***Acute myeloid leukemia*** - Acute myeloid leukemia is classified as a **malignant hematological disorder**, not a myeloproliferative disease, which includes chronic diseases with increased blood cell production. - It is characterized by the **rapid accumulation of immature blood cells**, leading to acute symptoms rather than a gradual proliferation. *Polycythemia vera* - Polycythemia vera is a myeloproliferative neoplasm resulting in an **increase in red blood cells**, causing symptoms like increased blood viscosity [1][2]. - It is associated with a mutation in the **JAK2 gene**, which leads to overproduction of erythrocytes [1][2]. *Chronic myeloid leukemia* - Chronic myeloid leukemia is a myeloproliferative disorder characterized by the proliferation of myeloid cells and often involves the **Philadelphia chromosome** [2][3]. - It shows a gradual increase in cell number and is typically diagnosed based on the presence of **elevated white blood cell counts**. *Essential thrombocytosis* - Essential thrombocytosis is a myeloproliferative neoplasm characterized by an **elevated platelet count**, increasing the risk of thrombotic events [1][2]. - Like other myeloproliferative disorders, it is associated with mutations in **JAK2** or other myeloid-related genes [1][2]. **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, p. 624. [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. 624-625.

Q: Intracorpuscular hemolytic anemia is seen in ?

Thalassemia. ***Thalassemia*** - Thalassemia is characterized by **intracorpuscular hemolysis** due to defective hemoglobin synthesis, leading to premature destruction of red blood cells [1][2]. - It manifests as **microcytic anemia** with associated **extramedullary erythropoiesis** in severe cases [1]. *Autoimmune hemolytic anemia* - This condition leads to **extravascular hemolysis**, primarily affecting red blood cells in the spleen, not within the plasma [2]. - It is often associated with **positive direct Coombs test**, indicating reactants on the RBC surface. *TIP* - TIP (Thrombotic Microangiopathy) primarily involves **microangiopathic hemolytic anemia** and is not classified as intracorpuscular [2]. - The hemolysis in TIP occurs due to **microthrombi**, causing damage to red blood cells as they pass through narrowed vessels. *Infection* - Infections can lead to **hemolysis**, but this is typically **extravascular** due to splenic clearance or due to other mechanisms like **malaria** [2]. - The hemolytic mechanism is not intracorpuscular, as seen in conditions like thalassemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 601-602. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 596-597.

Q: Donath-Landsteiner antibody is seen in?

Paroxysmal cold hemoglobinuria. ***Paroxysmal cold hemoglobinuria*** - **Donath-Landsteiner antibody** is a **biphasic IgG autoantibody** that binds to red blood cells in the cold and causes **hemolysis** upon warming, characteristic of paroxysmal cold hemoglobinuria. - This antibody has **anti-P specificity**, meaning it targets the P antigen on red blood cells, leading to complement activation and cell lysis. *PNH* - **Paroxysmal nocturnal hemoglobinuria** (PNH) is characterized by a deficiency in **GPI-anchored proteins** on red blood cells, notably **CD55** and **CD59**, making them susceptible to complement-mediated lysis. - It is not associated with the Donath-Landsteiner antibody; rather, it is identified by **flow cytometry** showing absence of CD55/CD59. *Waldenstrom's macroglobulinemia* - This is a **B-cell lymphoma** characterized by the overproduction of **monoclonal IgM antibodies**, leading to hyperviscosity syndrome and other symptoms. - It does not involve Donath-Landsteiner antibodies or cold-induced hemolysis in the same manner as paroxysmal cold hemoglobinuria. *Malaria* - **Malaria** is caused by **Plasmodium parasites** that infect and destroy red blood cells, leading to hemolytic anemia and fever. - While it causes **hemolysis**, it is not mediated by the Donath-Landsteiner antibody; the destruction is primarily due to parasitic replication and immune responses against infected cells.

Q: Which of the following statements about sickle cell anemia is false?

Ringed sideroblasts are associated with sickle cell anemia.. ***Ringed sideroblast*** - **Ringed sideroblasts** are not typically associated with sickle cell anemia; they are indicative of disorders like **sideroblastic anemia**. - In sickle cell anemia, the primary findings include **hemolysis** and ineffective erythropoiesis, not ringed sideroblasts [3]. *Howell jolly bodies* - These bodies are remnants of nuclear material and can be found in individuals with **spleen dysfunction**, which can occur in sickle cell anemia [1]. - They are actually a common finding due to **hyposplenism** or **asplenia** in patients with sickle cell disease [2]. *Sickle cells* - The presence of **sickle-shaped red blood cells** is a hallmark of sickle cell anemia, caused by the mutation in the **beta-globin chain** [3]. - These sickle cells are responsible for the characteristic complications of the disease, such as **vaso-occlusive crises** [1][3]. *Target cells* - Target cells, or **codocytes**, are often seen in disorders like **thalassemia** and liver disease, and can also be present in sickle cell anemia. - They are formed due to an increase in the **surface area to volume ratio** of red blood cells, often secondary to **membrane abnormalities** seen in sickle cell changes [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. 644-646. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 570-571. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 598-599.

Q: Which of the following statements about Polycythemia vera is false?

Increased LAP score. ***Decrease LAP score*** - In polycythemia vera, the **LAP (leukocyte alkaline phosphatase) score** is typically increased, indicating more mature leukocytes. - A **decrease in LAP score** is not consistent with the disease, making this statement incorrect. *Increased platelets* - Polycythemia vera often results in **thrombocytosis**, characterized by increased platelet counts [1]. - This is a common feature of the disorder, reflecting overproduction of blood cells in the bone marrow. *Leucocytosis* - Patients with polycythemia vera frequently exhibit **leucocytosis**, or increased white blood cell counts, due to hypercellularity of the bone marrow [1]. - This is an important aspect of the disease, often seen alongside increases in red blood cells and platelets. *Increased vit B12* - An elevation in **vitamin B12** levels can occur in polycythemia vera, often due to increased binding proteins. - This is a well-recognized phenomenon associated with the increased cell turnover in this condition. **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. 626-627.

Q: Thalassemia gives protection against ?

Protection against malaria. Protection against malaria - Individuals with thalassemia, particularly thalassemia trait, have some degree of protection against severe forms of malaria, specifically Plasmodium falciparum [1]. - The altered red blood cell structure and reduced hemoglobin content in thalassemia make the red blood cells less hospitable for the parasites, hindering their replication and survival [1]. Protection against filaria - Filaria is caused by parasitic worms (nematodes) transmitted by mosquitoes, leading to lymphatic filariasis (elephantiasis) or onchocerciasis (river blindness). - Thalassemia's primary impact is on red blood cell health and oxygen transport, offering no known protective effect against nematode infections or their associated pathology. Protection against kala-azar - Kala-azar (visceral leishmaniasis) is caused by Leishmania parasites transmitted by sandflies, primarily affecting the reticuloendothelial system (spleen, liver, bone marrow). - There is no established scientific evidence indicating that thalassemia provides protection against Leishmania infections or their clinical manifestations. Protection against leptospirosis - Leptospirosis is a bacterial infection caused by Leptospira bacteria, typically acquired through contact with contaminated water or animal urine. - Thalassemia is a genetic blood disorder; its physiological effects are unrelated to the mechanisms of infection or immunity against bacterial pathogens like Leptospira.

Q: What is the typical bone marrow finding in myelofibrosis?

Dry tap (hypocellular). ***Dry tap (hypocellular)*** - In myelofibrosis, the bone marrow is often **hypocellular** due to fibrosis [1][2], leading to a **dry tap** during aspiration. - The presence of **reticulin** and collagen deposition replaces normal hematopoietic cells [2], resulting in ineffective hematopoiesis. *Thrombocytosis* - Myelofibrosis typically leads to **thrombocytopenia**, not thrombocytosis, due to ineffective megakaryopoiesis and splenic sequestration. - Though elevated platelets can occur, they are generally a **secondary response** to the disease and not a hallmark finding. *Megaloblastic cells* - Megaloblastic changes are associated with **vitamin B12** or **folate deficiencies**, which do not occur in myelofibrosis. - In myelofibrosis, the predominant issue is **marrow fibrosis** [1][2], which does not lead to megaloblastosis. *Microcytic cells* - Microcytic cells are commonly linked to **iron deficiency anemia**, not myelofibrosis. - Myelofibrosis typically results in **variable red cell morphology** [1], but microcytic anemia is not a primary characteristic. **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. 628-629. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 615-616.

Question 1

The most common subtype of Non-Hodgkin's lymphoma in India is:

Accepted Answer

Diffuse large B cell lymphoma

Answer

Diffuse small cell lymphocytic lymphoma

Answer

Follicular lymphoma

Answer

Burkitt's lymphoma

Question 2

What is the Thomsen Friedenreich phenomenon?

Accepted Answer

Exposure of cryptic T-antigen on red blood cells

Answer

Agglutination of red blood cells by all blood group sera

Answer

Agglutination of red blood cells by anti-T antibodies

Answer

Association with certain malignancies

Question 3

ABO isoantibodies are of which class?

Accepted Answer

IgM

Answer

IgG

Answer

IgD

Answer

IgA

Question 4

Which of the following myeloid leukemias is not classified as a myeloproliferative neoplasm?

Accepted Answer

Acute myeloid leukemia

Answer

Chronic myeloid leukemia

Answer

Chronic lymphocytic leukemia

Answer

Acute lymphoblastic leukemia

Question 5

Intracorpuscular hemolytic anemia is seen in ?

Accepted Answer

Thalassemia

Answer

Infection

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Autoimmune hemolytic anemia

Question 6

Donath-Landsteiner antibody is seen in?

Accepted Answer

Paroxysmal cold hemoglobinuria

Answer

PNH

Answer

Waldenstrom's macroglobulinemia

Answer

Malaria

Question 7

Which of the following statements about sickle cell anemia is false?

Accepted Answer

Ringed sideroblasts are associated with sickle cell anemia.

Answer

Sickle cells are present in sickle cell anemia.

Answer

Target cells are commonly seen in sickle cell anemia.

Answer

Howell Jolly bodies can be found in sickle cell anemia.

Question 8

Which of the following statements about Polycythemia vera is false?

Accepted Answer

Increased LAP score

Answer

Increased vitamin B12 levels

Answer

Leukocytosis is present

Answer

Increased platelet count

Question 9

Thalassemia gives protection against ?

Accepted Answer

Protection against malaria

Answer

Protection against filaria

Answer

Protection against kala-azar

Answer

Protection against leptospirosis

Question 10

What is the typical bone marrow finding in myelofibrosis?

Accepted Answer

Dry tap (hypocellular)

Answer

Megaloblastic cells

Answer

Microcytic cells

Answer

Thrombocytosis

Hematopathology — MCQs

Hematopathology — MCQs

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