Hematopathology Practice Questions

Q: What do Döhle bodies represent in neutrophils?

Presence of dilated endoplasmic reticulum in neutrophils. ***Presence of dilated endoplasmic reticulum in neutrophils*** - **Döhle bodies** are inclusions found in the cytoplasm of neutrophils, classic hallmarks of **severe infection** or inflammatory conditions. - They represent remnants of dilated **rough endoplasmic reticulum**, which appears as pale-blue, irregular aggregates on stained blood smears. *Increased mitochondria in neutrophils* - An increase in mitochondria is not a characteristic feature associated with Döhle bodies. - While mitochondria are essential for cellular energy production, their proliferation does not form visible inclusions known as Döhle bodies. *Golgi apparatus proliferation in neutrophils* - Proliferation of the Golgi apparatus is not typically observed as a Döhle body. - The Golgi apparatus is involved in protein modification and packaging, but its changes do not manifest as these specific inclusions. *Lysosomal activity in neutrophils* - Lysosomal activity involves the breakdown of cellular debris and pathogens and is not directly related to the formation of Döhle bodies. - Although lysosomes are abundant in neutrophils, their activity does not result in the presence of Döhle bodies.

Q: Helmet cells are characteristic of anemia of?

Hemolytic uremic syndrome (HUS). ***Hemolytic uremic syndrome*** - Helmet cells are **fragmented red blood cells** associated with **microangiopathic hemolytic anemia** [1], commonly seen in hemolytic uremic syndrome. - This condition frequently results in **thrombocytopenia** and acute renal failure. *Acanthocytosis* - Acanthocytosis is characterized by **spiky red blood cells** (acanthocytes) rather than helmet cells. - It is commonly associated with **liver disease** and **abetalipoproteinemia**, not hemolytic anemia. *Polysplenia* - Polysplenia is a condition involving multiple spleens but does not typically relate to the **formation of helmet cells**. - It may cause **asplenic complications**, but anemia characteristics do not include helmet cells. *Spherocytosis* - Spherocytosis involves the presence of **spherical red blood cells** rather than fragmented (helmet) cells. - It is associated with **hereditary conditions** like hereditary spherocytosis, which leads to increased hemolysis but not typically to helmet cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 596-597.

Q: What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

Immature B cells. ***Immature B cells*** - B acute lymphoblastic leukemia (B ALL) is primarily derived from the **malignant transformation of precursor B lymphocytes** [1]. - The disease is characterized by the presence of **immature B cell blasts** in the bone marrow and peripheral blood [1]. *T cells* - T cells are involved in a different lineage of leukemia known as T-ALL, not B ALL [1]. - The pathophysiology of B ALL specifically relates to **B cell precursors**, not T cell involvement. *Both T & B cells* - This option is incorrect as B ALL specifically originates from **B cell lineage**, and T cells are unrelated to its pathogenesis [1]. - The presence of both T and B cells together characterizes mixed lineage leukemias, which is not the case here. *Immature T cells* - Immature T cells are precursors for **T acute lymphoblastic leukemia (T-ALL)**, not for B ALL [1]. - B ALL does not involve T cell precursors; the focus is solely on **immature B cells** [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. 596-600.

Q: Which type of immunoglobulin is primarily associated with cold agglutinin disease?

IgM. ***IgM*** - Cold agglutinins are primarily composed of **IgM antibodies** [1] which are produced in response to certain infections, notably Mycoplasma pneumoniae. - They can cause **cold agglutinin disease**, leading to hemolytic anemia when the blood is exposed to cooler temperatures [2]. *IgG* - While IgG is the most abundant antibody in blood, it is not responsible for cold agglutination. - IgG typically functions in **immune memory** and neutralization rather than agglutination at cold temperatures. *IgD* - IgD is mainly found on the surface of **B cells** and has a role in initiating B cell activation. - It plays a minimal role in the antibody response and does not participate in cold agglutination. *IgA* - IgA is primarily involved in mucosal immunity, found in secretions like saliva and tears. - It does not function as a cold agglutinin; hence, it is not associated with cold temperature-related agglutination. **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. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 651-652.

Q: Starry sky appearance is seen in which of the following?

Burkitt's Lymphoma. ***Burkitts lymphoma*** - The **starry sky appearance** is a characteristic histopathological finding due to interspersed macrophages containing **phagocytosed apoptotic cells** and necrotic debris in Burkitt's lymphoma [1]. - It is associated with **MYC gene translocation** and presents typically in children or young adults, commonly affecting the **jaw or abdomen**. *CIL* - CIL (chronic inflammatory leukocytosis) does not exhibit a **starry sky appearance**; it typically reflects a reactive process without specific histological features. - The histology is more characterized by **increased white blood cell counts** rather than tissue architecture alterations seen in lymphomas. *Diffuse large B cell lymphoma* - While this lymphoma can show **varied morphology**, it does not have a **starry sky appearance** as a defining feature, rather presenting with **large atypical B-cells**. - The histological appearance is generally of a **diffuse infiltrate**, which lacks the classic starry sky histology. *ALCL* - Anaplastic large cell lymphoma (ALCL) is characterized by **large, pleomorphic cells** but does not show a starry sky appearance. - The histological pattern primarily focuses on **large anaplastic lymphoid cells** rather than the scattered macrophages seen in Burkitt's lymphoma. **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. 606.

Q: Which of the following is not typically seen in Disseminated Intravascular Coagulation (DIC)?

Normal aPTT. ***Normal APTT*** - In Disseminated Intravascular Coagulation (**DIC**), **APTT** is typically **prolonged** due to consumption of clotting factors [1]. - The presence of normal APTT indicates that coagulation pathways are not significantly affected, which is contrary to what is seen in DIC. *Fibrinogen decreased* - **Decreased fibrinogen levels** are common in DIC, reflecting its consumption during the coagulation process [1]. - This depletion is linked to the increased clotting and is a hallmark of DIC, making this statement false in the context of the question. *Thrombocytopenia* - **Thrombocytopenia** occurs in DIC as platelets are consumed during the formation of microclots [1]. - A significant drop in platelet count is a key feature of DIC, therefore this statement does not align with the "except" clause. *PT elevation* - Prothrombin Time (**PT**) is usually **elevated** in DIC due to the consumption of clotting factors [1]. - This reflects the ongoing activation of the coagulation cascade, supporting the exclusion in the question context. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 625-626.

Q: All of the following provide protection against malaria except which of the following?

PNH. ***PNH*** - Paroxysmal Nocturnal Hemoglobinuria (PNH) does not provide any **protection against malaria**; it is an acquired bone marrow disorder. - While it leads to increased hemolysis and thrombosis, it does not affect **malaria susceptibility** directly. *Duffy blood group* - The Duffy blood group has specific antigens that are a **receptor for Plasmodium vivax**, making individuals with a Duffy-negative phenotype resistant to this type of malaria. - Therefore, Duffy blood group status can indeed serve as a protective factor against certain malaria strains. *Hereditary spherocytosis* - This condition results in **spherical red blood cells** [1], causing hemolytic anemia, but it does not confer protection against malaria. - People with hereditary spherocytosis do not have a lower prevalence of malaria and may still be susceptible to infection. *Sickle cell anemia* - Individuals with sickle cell anemia often exhibit **increased resistance to malaria**, especially against Plasmodium falciparum [2]. - The sickling of red blood cells under low oxygen conditions creates an unfavorable environment for the malarial parasites to thrive [2, 3].

Q: Which of the following conditions is the classic example of acute intravascular hemolysis triggered by oxidative stress?

Acute G6PD deficiency. ***b and c*** - Intravascular hemolysis is commonly associated with both **Acute G6PD deficiency** and **Hereditary spherocytosis**, leading to destruction of red blood cells in the bloodstream [1]. - These conditions are characterized by **high levels of hemoglobinuria** and **low haptoglobin**, indicative of intravascular hemolysis. *Sickle cell ds* - Sickle cell disease primarily causes **extravascular hemolysis** due to splenic sequestration rather than **intravascular** destruction [3]. - The clinical features include **vaso-occlusive crises** and splenic infarction rather than hemolysis within the blood vessels. *Acute G6PD* - While acute G6PD deficiency can lead to hemolysis, it is typically **triggered by oxidative stress** rather than occurring continuously [2]. - The hemolysis in G6PD deficiency occurs more in an **extravascular** manner unless acute stress occurs, which can result in **acute intravascular hemolysis, marked by anemia, hemoglobinemia, and hemoglobinuria** [4]. *Hereditary spherocytosis* - This condition primarily causes **extravascular hemolysis** through the spleen, where abnormal spherocytes are destroyed [1]. - Although it leads to anemia, the hallmark of hereditary spherocytosis is the **spleen's role** in hemocyte destruction rather than intravascular hemolysis.

Q: PNH patients have deficient surface proteins that normally protect red blood cells from activated complements. Which two surface proteins are deficient in these patients?

CD 45 and CD 55. ***CD 55 and CD 59*** - **CD 55 (decay accelerating factor)** and **CD 59 (protectin)** are crucial for inhibiting the complement system, protecting red blood cells from lysis in PNH. - Deficiencies in these proteins lead to increased **susceptibility** of red cells to **complement-mediated hemolysis**. *CD58 and CD 59* - **CD 58** is involved in T-cell interaction but does not solely protect red cells from complement. - While **CD 59** is a correct answer, the absence of **CD 55** makes this option incorrect for PNH. *CD 45 and CD 59* - **CD 45** is primarily a **leukocyte common antigen**, not involved in protecting red cells from complement activation. - This orrectly mentions **CD 59**, but lacks **CD 55**, making it unsuitable as an answer. *CD 51 and CD 59* - **CD 51** is associated with integrin functions and does not play a role in protecting red blood cells from complements. - Although **CD 59** is relevant, the deficiency in **CD 55** highlights the incompleteness of this option.

Question 1

What do Döhle bodies represent in neutrophils?

Accepted Answer

Presence of dilated endoplasmic reticulum in neutrophils

Answer

Increased mitochondria in neutrophils

Answer

Golgi apparatus proliferation in neutrophils

Answer

Lysosomal activity in neutrophils

Question 2

Helmet cells are characteristic of anemia of?

Accepted Answer

Hemolytic uremic syndrome (HUS)

Answer

Disseminated intravascular coagulation (DIC)

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Autoimmune hemolytic anemia (AIHA)

Question 3

What is the cell of origin of B-cell Acute Lymphoblastic Leukemia (B-ALL)?

Accepted Answer

Immature B cells

Answer

T cells

Answer

Immature T cells

Answer

Both T & B cells

Question 4

Which type of immunoglobulin is primarily associated with cold agglutinin disease?

Accepted Answer

IgM

Answer

IgG

Answer

IgA

Answer

IgD

Question 5

Starry sky appearance is seen in which of the following?

Accepted Answer

Burkitt's Lymphoma

Answer

Diffuse Large B Cell Lymphoma

Answer

Anaplastic Large Cell Lymphoma (ALCL)

Answer

Follicular Lymphoma

Question 6

Which of the following is not typically seen in Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Normal aPTT

Answer

Thrombocytopenia

Answer

PT elevation

Answer

Fibrinogen decreased

Question 7

All of the following provide protection against malaria except which of the following?

Accepted Answer

PNH

Answer

Sickle cell anemia

Answer

Hereditary spherocytosis

Answer

Duffy blood group

Question 8

Which of the following conditions is the classic example of acute intravascular hemolysis triggered by oxidative stress?

Accepted Answer

Acute G6PD deficiency

Answer

Hereditary spherocytosis

Answer

Sickle cell disease

Answer

None of the options

Question 9

PNH patients have deficient surface proteins that normally protect red blood cells from activated complements. Which two surface proteins are deficient in these patients?

Accepted Answer

CD 45 and CD 55

Answer

CD 55 and CD 58

Answer

CD 55 and CD 59

Answer

CD 51 and CD 55

Question 10

A 68-year-old woman was admitted with a history of weakness for two months. On examination, cervical lymph nodes were found enlarged and the spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dL, platelet count 27 × 10^9/L, and total leukocyte count 40 × 10^9/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20, and CD23, and negative for CD79B and FMC-7. The histopathological examination of the lymph node in this patient will most likely exhibit effacement of lymph node architecture by?

Accepted Answer

A monomorphic lymphoid proliferation with admixed proliferation centers

Answer

A polymorphous population of lymphocytes, plasma cells, eosinophils and scattered large binucleated cells

Answer

A predominantly follicular pattern with variably-sized follicles effacing nodal architecture

Answer

A diffuse proliferation of medium to large lymphoid cells with high mitotic rate

Hematopathology — MCQs

Hematopathology — MCQs

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