Hematopathology Practice Questions

Q: Storage temperature of RBC, Platelet, and Fresh Frozen Plasma (FFP) are:

RBC 2-6°C, Platelet 20-24°C, FFP -30°C. **RBC 2-6°C, Platelet 20-22°C, FFP -30°C** - **Red blood cells (RBCs)** are stored at **2-6°C** to slow metabolic activity and maintain viability for up to 42 days, depending on the anticoagulant. - **Platelets** require storage at **20-24°C** with continuous agitation to prevent aggregation and maintain their function for up to 5-7 days [1]. - **Fresh Frozen Plasma (FFP)** is stored at **-18°C or colder (often -30°C)** within 8 hours of collection to preserve labile clotting factors, particularly Factors V and VIII [2]. *RBC 20-22°C, Platelet 2-6°C, FFP -30°C* - Storing **RBCs** at **20-22°C** would lead to rapid bacterial growth and spoilage, making them unsafe for transfusion and shortening their shelf life significantly. - Storing **platelets** at **2-6°C** would cause them to lose their function due to activation and aggregation, rendering them ineffective for treating bleeding [1]. *RBC -30°C, FFP 2-6°C, Platelet 20-22°C* - Storing **RBCs** at **-30°C** without cryoprotectants would cause them to hemolyze due to ice crystal formation, destroying their integrity. - Storing **FFP** at **2-6°C** would lead to the degradation of labile clotting factors, particularly factors V and VIII, within hours, making it ineffective for coagulation deficiencies [2]. *RBC 20-22°C, FFP -30°C, Platelet 2-6°C* - Storing **RBCs** at **20-22°C** would significantly increase their metabolic rate and risk of bacterial contamination, shortening their viable storage period to only hours. - Storing **platelets** at **2-6°C** would impair their function, causing them to aggregate and become unviable for transfusion [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 581-583. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 582-583.

Q: Which is NOT a feature of microangiopathic hemolytic anemia?

Spherocytes. ***Spherocytes*** - **Spherocytes** are typically found in conditions like **hereditary spherocytosis** or **autoimmune hemolytic anemia**, where red blood cells are damaged or improperly formed, leading to a spherical shape [1]. - In **microangiopathic hemolytic anemia (MAHA)**, red cells are fragmented by shear stress from damaged small blood vessels, resulting in **schistocytes**, not spherocytes. *High LDH* - **Lactate dehydrogenase (LDH)** is an intracellular enzyme released when red blood cells are destroyed, making **elevated LDH** a common finding in hemolytic anemias, including MAHA. - Its high levels reflect increased red cell turnover and destruction in the microvasculature. *Schistocytes* - **Schistocytes**, or fragmented red blood cells, are the **hallmark** of microangiopathic hemolytic anemia. - They are formed when red blood cells pass through damaged small blood vessels containing fibrin strands, leading to their shearing and destruction. *Low haptoglobin* - **Haptoglobin** is a plasma protein that binds free hemoglobin released during red blood cell destruction. - In hemolytic anemias like MAHA, there is increased hemoglobin release, which saturates and depletes haptoglobin, leading to **low or undetectable levels**. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 602-603.

Q: In ABO blood grouping, which is False?

ABO antibodies are natural and present since birth. ***ABO antibodies are natural and present since birth*** - **ABO antibodies** are naturally occurring, but they are typically **not present at birth** [1]. - They develop within the **first 3 to 6 months of life** as a response to exposure to similar antigens in the environment (e.g., bacteria). *IgM is most common antibody in ABO* - The primary **ABO antibodies** (anti-A, anti-B) are indeed predominantly **IgM antibodies** [1]. - IgM antibodies are large pentameric structures, and their size prevents them from crossing the placenta [2]. *ABO are carbohydrate Ag* - The **ABO blood group antigens** (A, B, H) are **carbohydrate structures** (glycans) found on the surface of red blood cells and other tissues. - These carbohydrate chains are attached to proteins or lipids. *Ab are present only if Ag is absent* - This statement is a fundamental principle of ABO blood grouping: individuals naturally produce antibodies against the **ABO antigens** they **lack** [1]. - For example, a person with **Type A blood** (A antigen present) will have **anti-B antibodies** (B antigen absent). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of Infancy and Childhood, pp. 469-470.

Q: What is the primary site of involvement in multiple myeloma?

Bone marrow. ***Bone marrow*** - Multiple myeloma is a **B-cell malignancy** characterized by the uncontrolled proliferation of **plasma cells** in the bone marrow [1]. - These malignant plasma cells produce an abnormal **monoclonal immunoglobulin** (M protein) and can cause lytic bone lesions [2]. *Lungs* - While lung involvement can occur in advanced or unusual cases of multiple myeloma (e.g., through extramedullary plasmacytomas), it is **not the primary site** of the disease. - Primary lung malignancies or metastases from other cancers are more common causes of lung pathology. *Liver* - **Liver infiltration** by myeloma cells is rare and usually indicates widespread disease or extramedullary involvement, not the initial or primary site. - The liver's primary role in hematologic malignancies often involves metabolism or effects on coagulation, not as a primary site of plasma cell proliferation. *Spleen* - **Splenomegaly** can sometimes be observed in multiple myeloma due to extramedullary hematopoiesis or infiltration, but it is **not the primary site** for plasma cell proliferation. - Lymphomas and leukemias are more typically associated with primary splenic involvement. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-618. [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. 606-608.

Q: Which protein is a key marker of Reed-Sternberg cells in Hodgkin's lymphoma?

CD15. ***CD15*** - **CD15** (along with **CD30**) is a characteristic **immunophenotypic marker** of **Reed-Sternberg cells** in **classical Hodgkin's lymphoma** [1]. - The classic immunophenotype is **CD30+/CD15+/CD45-/CD20-** (CD20 may be weakly positive in some cases). - **CD30 is the most sensitive marker** (positive in >95% of cases), while **CD15 is positive in 75-85%** of classical Hodgkin's lymphoma cases. - Both markers together aid in the definitive diagnosis and differentiation of Hodgkin's lymphoma from other lymphomas. *CD19* - **CD19** is an important **B-cell marker** expressed on normal B lymphocytes and in most B-cell non-Hodgkin lymphomas, but it is typically **negative** in Reed-Sternberg cells [1]. - Its presence usually points away from Hodgkin's lymphoma and towards a B-cell lineage malignancy. *CD20* - **CD20** is another key **B-cell marker** found on the surface of normal B lymphocytes and **most B-cell non-Hodgkin lymphomas**. - Reed-Sternberg cells usually **lack CD20 expression** (or show only weak positivity in 20-40% of cases), helping to distinguish Hodgkin's lymphoma from B-cell non-Hodgkin lymphomas [1]. *CD45* - **CD45** (also known as leukocyte common antigen, LCA) is expressed on nearly all **hematopoietic cells**, including most lymphomas. - However, **Reed-Sternberg cells are typically negative or only weakly positive for CD45**, which is a significant diagnostic feature that helps differentiate Hodgkin's lymphoma from many non-Hodgkin lymphomas [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. 614-618.

Q: A 50-year-old male presents with fatigue and generalized lymphadenopathy. A lymph node biopsy reveals a starry sky pattern. What is the most likely diagnosis?

Burkitt lymphoma. ***Burkitt lymphoma*** - Characterized by a **starry sky pattern** on histology due to numerous **macrophages** engulfing apoptotic cells [1], commonly associated with a **MYC** mutation. - Typical clinical presentations include **fast-growing lymphadenopathy** and possible **abdominal masses**, aligning with the patient's symptoms of fatigue and lymphadenopathy. *Diffuse large B-cell lymphoma* - Typically shows a variety of cellular patterns but does not exhibit the distinct **starry sky** pattern. - Often presents with **more aggressive symptoms** and is associated with **B symptoms** like fever and night sweats, which are not mentioned here. *Follicular lymphoma* - Histologically presents with **follicles and centrocytes**, differing from the **starry sky pattern** seen in Burkitt lymphoma. - Generally involves **indolent** symptoms, often more chronic than the acute presentation observed in this patient. *Hodgkin lymphoma* - Characterized by **Reed-Sternberg cells** and typically shows a **continuous** pattern of lymph node involvement, unlike the **starry sky** pattern. - Usually associated with **B symptoms** like fever and weight loss, which are not reported in 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, p. 606.

Q: A 6-year-old boy presents with a rapidly enlarging jaw mass. Histology reveals a 'starry sky' appearance. What is the most likely diagnosis?

Burkitt lymphoma. ***Burkitt lymphoma*** - Characterized by a **rapidly enlarging jaw mass** [1] and the presence of a **'starry sky' appearance** [2] on histology due to interspersed macrophages in a background of dense, proliferative B-lymphoid tissue. - Most common in children [1], often associated with **endemic forms** in Africa linked to **EBV** infection. *Acute lymphoblastic leukemia* - Typically presents with **bone marrow infiltration**, leading to symptoms like **anemia**, **thrombocytopenia**, and **leukopenia**, rather than a localized mass. - Histological findings would show **lymphoblasts** but not a 'starry sky' pattern. *Hodgkin lymphoma* - Generally presents with **painless lymphadenopathy** rather than a **rapidly growing jaw mass**, and involves **Reed-Sternberg cells** on histology. - The classic presentation does not include the characteristic 'starry sky' appearance associated with Burkitt lymphoma. *Diffuse large B-cell lymphoma* - Often presents as a **mass** but is more typically seen in older adults and does not have the **'starry sky' appearance** associated with Burkitt lymphoma. - Histologically, it would show **large B-cells** and is less aggressive in its clinical presentation compared to Burkitt 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, pp. 605-606. [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. 606.

Q: In the calculation of Mean Corpuscular Volume (MCV), which formula is correct?

(Hematocrit × 10) / RBC count. **Correct: (Hematocrit × 10) / RBC count** - This formula correctly calculates the **Mean Corpuscular Volume (MCV)**, representing the average volume of red blood cells. - The multiplication by **10** is included to adjust units, typically with hematocrit in percentage and RBC count in millions/µL, to yield MCV in femtoliters (fL). - Normal MCV range: 80-100 fL *Incorrect: (Hematocrit × 100) / RBC count* - This formula is incorrect because multiplying the hematocrit by **100** instead of 10 would lead to an excessively large and inaccurate MCV value (10 times higher than actual). - The standard unit conversion requires a factor of **10** to correctly express MCV in femtoliters. *Incorrect: (Hematocrit × 10) / Total blood volume* - This formula is incorrect as **total blood volume** is not a component used in the direct calculation of Mean Corpuscular Volume. - MCV is derived from the hematocrit and RBC count, reflecting the average size of individual red blood cells. *Incorrect: (Hemoglobin × 10) / Hematocrit* - This formula is incorrect for calculating MCV; it actually represents the formula for **Mean Corpuscular Hemoglobin Concentration (MCHC)**, which measures the average concentration of hemoglobin in red blood cells. - MCV specifically measures the **average volume** of red blood cells, not their hemoglobin content or concentration.

Q: A 30-year-old male presents with fatigue and easy bruising. A peripheral blood smear shows blasts with Auer rods. Which cytogenetic abnormality is most likely associated with his condition?

t(15;17). ***t(15;17)*** - The presence of **Auer rods** in blasts strongly suggests **Acute Myeloid Leukemia (AML)**, specifically the **M3 subtype** (Acute Promyelocytic Leukemia or APL) [1]. - **APL** is classically associated with the **t(15;17) translocation**, which involves the **PML** and **RARA** genes [1]. *t(8;21)* - This translocation is associated with another subtype of **AML**, specifically **AML with maturation** (M2), but it is not typically linked to the prominent presence of **Auer rods** like APL [1]. - While it is a recurrent cytogenetic abnormality in AML, it does not fit the classic presentation as well as t(15;17). *inv(16)* - The **inv(16)** (or t(16;16)) abnormality is characteristic of **AML with eosinophilia** (M4eo), a different subtype of AML [1]. - While it can be associated with some myeloid differentiation, it's not the primary association with abundant **Auer rods** and the classic APL picture [1]. *t(9;22)* - This translocation, also known as the **Philadelphia chromosome**, is primarily associated with **Chronic Myeloid Leukemia (CML)**. - Although it can also be found in some cases of acute lymphoblastic leukemia (ALL) and rarely in AML, it is not consistently associated with the presence of **Auer rods** and is not the most likely diagnosis in this clinical context. **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. 620-622.

Question 1

Storage temperature of RBC, Platelet, and Fresh Frozen Plasma (FFP) are:

Accepted Answer

RBC 2-6°C, Platelet 20-24°C, FFP -30°C

Answer

RBC 20-22°C, Platelet 2-6°C, FFP -30°C

Answer

RBC -30°C, FFP 2-6°C, Platelet 20-22°C

Answer

RBC 20-22°C, FFP -30°C, Platelet 2-6°C

Question 2

Which is NOT a feature of microangiopathic hemolytic anemia?

Accepted Answer

Spherocytes

Answer

High LDH

Answer

Schistocytes

Answer

Low haptoglobin

Question 3

Which is TRUE about JAK2 V617F mutation?

Accepted Answer

Seen in PV, ET, and PMF but rare in CML.

Answer

Seen in ET.

Answer

Rare in CML.

Answer

Common in PV but not specific.

Question 4

In ABO blood grouping, which is False?

Accepted Answer

ABO antibodies are natural and present since birth

Answer

IgM is most common antibody in ABO

Answer

ABO are carbohydrate Ag

Answer

Ab are present only if Ag is absent

Question 5

What is the primary site of involvement in multiple myeloma?

Accepted Answer

Bone marrow

Answer

Lungs

Answer

Liver

Answer

Spleen

Question 6

Which protein is a key marker of Reed-Sternberg cells in Hodgkin's lymphoma?

Accepted Answer

CD15

Answer

CD19

Answer

CD20

Answer

CD45

Question 7

A 50-year-old male presents with fatigue and generalized lymphadenopathy. A lymph node biopsy reveals a starry sky pattern. What is the most likely diagnosis?

Accepted Answer

Burkitt lymphoma

Answer

Hodgkin lymphoma

Answer

Diffuse large B-cell lymphoma

Answer

Follicular lymphoma

Question 8

A 6-year-old boy presents with a rapidly enlarging jaw mass. Histology reveals a 'starry sky' appearance. What is the most likely diagnosis?

Accepted Answer

Burkitt lymphoma

Answer

Hodgkin lymphoma

Answer

Diffuse large B-cell lymphoma

Answer

Acute lymphoblastic leukemia

Question 9

In the calculation of Mean Corpuscular Volume (MCV), which formula is correct?

Accepted Answer

(Hematocrit × 10) / RBC count

Answer

(Hemoglobin × 10) / Hematocrit

Answer

(Hematocrit × 100) / RBC count

Answer

(Hematocrit × 10) / Total blood volume

Question 10

A 30-year-old male presents with fatigue and easy bruising. A peripheral blood smear shows blasts with Auer rods. Which cytogenetic abnormality is most likely associated with his condition?

Accepted Answer

t(15;17)

Answer

t(8;21)

Answer

inv(16)

Answer

t(9;22)

Hematopathology — MCQs

Hematopathology — MCQs

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