Hematopathology — MCQs

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1321: Storage temperature of RBC, Platelet, and Fresh Frozen Plasma (FFP) are:

A. RBC 20-22°C, Platelet 2-6°C, FFP -30°C
B. RBC -30°C, FFP 2-6°C, Platelet 20-22°C
C. RBC 20-22°C, FFP -30°C, Platelet 2-6°C
D. RBC 2-6°C, Platelet 20-24°C, FFP -30°C (Correct Answer)

Explanation: **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.

Question 1322: Which is NOT a feature of microangiopathic hemolytic anemia?

A. Spherocytes (Correct Answer)
B. High LDH
C. Schistocytes
D. Low haptoglobin

Explanation: ***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.

Question 1323: Which is TRUE about JAK2 V617F mutation?

A. Seen in ET.
B. Rare in CML.
C. Common in PV but not specific.
D. Seen in PV, ET, and PMF but rare in CML. (Correct Answer)

Explanation: ***Seen in PV, ET, and PMF but rare in CML.*** - The **JAK2 V617F mutation** is a hallmark of classic Philadelphia chromosome-negative **myeloproliferative neoplasms (MPNs)**, including **polycythemia vera (PV)** (~95%), **essential thrombocythemia (ET)** (~50-60%), and **primary myelofibrosis (PMF)** (~50-60%) [1]. - It is **rare in chronic myeloid leukemia (CML)**, which is defined by the **BCR-ABL1 fusion gene** [1]. - This option provides the **most comprehensive and accurate** description of JAK2 V617F distribution across myeloproliferative disorders. *Seen in ET.* - While the **JAK2 V617F mutation** is indeed found in approximately 50-60% of patients with **essential thrombocythemia (ET)**, this statement is **incomplete** [2]. - It fails to mention the mutation's presence in other MPNs (PV and PMF) and its rarity in CML, making it a partial truth rather than the best answer. *Rare in CML.* - This statement is **medically accurate** - JAK2 V617F is indeed **rare in CML**, as CML is characterized by the **BCR-ABL1 translocation** [1]. - However, this option is **incomplete** as it omits crucial information about the mutation's presence in PV, ET, and PMF. - Knowing where the mutation IS found is more clinically useful than only knowing where it's rare. *Common in PV but not specific.* - This statement is **technically correct** - the **JAK2 V617F mutation** is found in about 95% of patients with **polycythemia vera (PV)**, making it very **common** in this condition [2]. - The phrase "**not specific**" is also accurate because the mutation is found in other MPNs (ET and PMF), not exclusively in PV [1]. - However, this option is less complete than the correct answer because it doesn't describe the full distribution pattern across all major MPNs or mention its rarity in CML. **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. 624. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 614-615.

Question 1324: In ABO blood grouping, which is False?

A. IgM is most common antibody in ABO
B. ABO are carbohydrate Ag
C. ABO antibodies are natural and present since birth (Correct Answer)
D. Ab are present only if Ag is absent

Explanation: ***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.

Question 1325: What is the primary site of involvement in multiple myeloma?

A. Lungs
B. Bone marrow (Correct Answer)
C. Liver
D. Spleen

Explanation: ***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.

Question 1326: Which protein is a key marker of Reed-Sternberg cells in Hodgkin's lymphoma?

A. CD19
B. CD20
C. CD15 (Correct Answer)
D. CD45

Explanation: ***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.

Question 1327: 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?

A. Burkitt lymphoma (Correct Answer)
B. Hodgkin lymphoma
C. Diffuse large B-cell lymphoma
D. Follicular lymphoma

Explanation: ***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.

Question 1328: A 6-year-old boy presents with a rapidly enlarging jaw mass. Histology reveals a 'starry sky' appearance. What is the most likely diagnosis?

A. Burkitt lymphoma (Correct Answer)
B. Hodgkin lymphoma
C. Diffuse large B-cell lymphoma
D. Acute lymphoblastic leukemia

Explanation: ***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.

Question 1329: In the calculation of Mean Corpuscular Volume (MCV), which formula is correct?

A. (Hematocrit × 10) / RBC count (Correct Answer)
B. (Hemoglobin × 10) / Hematocrit
C. (Hematocrit × 100) / RBC count
D. (Hematocrit × 10) / Total blood volume

Explanation: **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.

Question 1330: Which condition is most commonly associated with the presence of Reed-Sternberg cells in a lymph node biopsy?

A. Hodgkin's lymphoma (Correct Answer)
B. Non-Hodgkin's lymphoma
C. Multiple myeloma
D. Leukemia

Explanation: ***Hodgkin's lymphoma*** - The presence of **Reed-Sternberg cells** is a hallmark feature of Hodgkin's lymphoma, indicating **malignancy of lymphoid tissue** [1]. - These giant cells are often associated with **lymph node enlargement** and may present with **B symptoms** (fever, weight loss, night sweats) [1]. *Non-Hodgkin's lymphoma* - Does not typically show **Reed-Sternberg cells**, instead featuring a variety of **cell types** depending on the specific subtype. - Associated with **larger, often multiple lymphoid nodes**, but lacks the distinctive cell morphology seen in Hodgkin's lymphoma. *Multiple myeloma* - Characterized by the proliferation of **monoclonal plasma cells** in the bone marrow, not Reed-Sternberg cells. - Patients may exhibit **bone pain**, **anemia**, and **renal problems**, which are unrelated to Reed-Sternberg presence. *Leukemia* - Primarily involves the **bone marrow** and **blood**, not lymph nodes, and does not feature Reed-Sternberg cells. - Symptoms are more related to **cytopenias** and the **overproduction of abnormal leukocytes** rather than lymphadenopathy. **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.

Practice by Chapter

Anemias: Classification and Approach

Practice Questions

Hemolytic Anemias

Practice Questions

Myeloproliferative Neoplasms

Practice Questions

Myelodysplastic Syndromes

Practice Questions

Acute Leukemias

Practice Questions

Chronic Leukemias

Practice Questions

Lymphomas and Lymphoid Neoplasms

Practice Questions

Plasma Cell Disorders

Practice Questions

Bleeding Disorders

Practice Questions

Thrombotic Disorders

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free