Hematopathology — MCQs

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1331: 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?

A. t(8;21)
B. t(15;17) (Correct Answer)
C. inv(16)
D. t(9;22)

Explanation: ***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 1332: A peripheral blood smear from a patient with a history of alcohol abuse shows hypersegmented neutrophils and oval macrocytes. Which underlying condition is most likely?

A. Folate Deficiency (Correct Answer)
B. Iron Deficiency Anemia
C. Lead Poisoning
D. Thalassemia

Explanation: ***Folate Deficiency*** - Hypersegmented neutrophils and **oval macrocytes** are key features indicative of **megaloblastic anemia** [1], primarily resulting from folate deficiency. - Alcohol abuse can impede folate absorption, leading to significant deficiencies and is commonly associated with these laboratory findings [2]. *Lead Poisoning* - Typically shows **basophilic stippling** of red blood cells and does not lead to hypersegmented neutrophils. - Presents with **anemia**, but the morphology is different, lacking the macrocytosis seen in folate deficiency. *Iron Deficiency Anemia* - Characterized by **microcytic hypochromic red blood cells** on blood smear, which differs from the **macrocytic** picture seen in this case. - Does not present with hypersegmented neutrophils, making it an unlikely cause here. *Thalassemia* - Presents with **microcytic anemia** and target cells, rather than macrocytic changes. - The findings of hypersegmented neutrophils and oval macrocytes are inconsistent with thalassemia's characteristic features. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 593-594. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 594-595.

Question 1333: A patient's serum sample shows the presence of antibodies that cause agglutination of red blood cells in the presence of a specific antigen. What type of antigen-antibody reaction is this, and what is its clinical relevance?

A. Agglutination; useful in blood typing and crossmatching (Correct Answer)
B. Precipitation; useful in detecting soluble antigens
C. Neutralization; used in viral serology
D. Complement fixation; indicative of complement activation

Explanation: ***Agglutination; useful in blood typing and crossmatching*** - This describes **agglutination**, where antibodies bind to **particulate antigens** such as those on red blood cells, causing them to clump together. - Its clinical relevance lies primarily in **blood typing** (ABO/Rh systems) and **crossmatching** to ensure compatibility before transfusions, preventing severe hemolytic reactions [1]. *Precipitation; useful in detecting soluble antigens* - **Precipitation** reactions involve antibodies binding to **soluble antigens** to form an insoluble complex that settles out of solution. - While useful for detecting soluble antigens (e.g., in immunodiffusion), it does not involve the clumping of particulate cells like red blood cells. *Neutralization; used in viral serology* - **Neutralization** reactions involve antibodies binding to toxins or viruses, thereby **blocking their biological activity** or infectivity. - It is crucial in **viral serology** and toxin detection but does not result in the agglutination of cells. *Complement fixation; indicative of complement activation* - **Complement fixation** tests detect the presence of antibodies or antigens by observing whether the **complement system** is activated and consumed in the process. - This process involves a complex cascade and does not directly manifest as the visible clumping of red blood cells. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628.

Question 1334: A peripheral blood smear shows target cells, poikilocytosis, and basophilic stippling. Which condition is most likely associated with these findings?

A. Iron Deficiency Anemia
B. Sideroblastic Anemia
C. Thalassemia (Correct Answer)
D. Pernicious Anemia

Explanation: ***Thalassemia*** - **Target cells**, **poikilocytosis**, and **basophilic stippling** are classic findings in thalassemia due to defective hemoglobin synthesis leading to an accumulation of unassembled globin chains [1]. - The abnormal globin chains precipitate, damaging red blood cell membranes, and leading to their premature destruction and characteristic dysmorphic features [1]. *Iron Deficiency Anemia* - This condition primarily presents with **microcytic, hypochromic red cells** and often significant anisocytosis (variation in size) and poikilocytosis (variation in shape), but **target cells** and **basophilic stippling** are not typically prominent features [2]. - While red cell morphology can be abnormal, the combination described is not characteristic of uncomplicated iron deficiency. *Sideroblastic Anemia* - Characterized by **ring sideroblasts** in the bone marrow, meaning iron accumulates in the mitochondria around the nucleus of erythroid precursors. Peripheral smear findings are often dimorphic, with some microcytic hypochromic cells and some larger, normochromic cells, and occasional **Pappenheimer bodies** (siderotic granules). - While some poikilocytosis might be present, extensive **target cells** and **basophilic stippling** are not the hallmark features. *Pernicious Anemia* - This is a type of **macrocytic anemia** caused by vitamin B12 deficiency (often due to intrinsic factor deficiency). - Peripheral smear shows **macro-ovalocytes**, **hypersegmented neutrophils**, and moderate to severe anisocytosis and poikilocytosis, but not target cells or basophilic stippling. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 648. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Question 1335: A 28-year-old woman presents with intermittent fever and joint pain. A biopsy of the lymph node reveals large, binucleated cells with prominent nucleoli. Which diagnostic test would confirm the probable diagnosis?

A. CD30 and CD15 immunohistochemistry (Correct Answer)
B. Bone marrow biopsy
C. Serum lactate dehydrogenase
D. Peripheral blood smear

Explanation: ***CD30 and CD15 immunohistochemistry*** - The presence of **large, binucleated cells with prominent nucleoli** (Reed-Sternberg cells) in a lymph node biopsy is highly characteristic of **Hodgkin lymphoma** [1]. - **Reed-Sternberg cells** typically express **CD30 and CD15**, and immunohistochemical staining for these markers is crucial for confirming the diagnosis of Hodgkin lymphoma [2]. *Bone marrow biopsy* - While a bone marrow biopsy may be performed for **staging** in Hodgkin lymphoma to check for marrow involvement, it is not the primary diagnostic test to confirm the initial diagnosis. - The characteristic Reed-Sternberg cells are found in the lymph nodes, not routinely in the bone marrow unless there is advanced disease [1]. *Serum lactate dehydrogenase* - **Serum LDH** can be elevated in various lymphomas and other conditions, indicating high tumor burden or cell turnover. - However, it is a **non-specific marker** and cannot confirm the specific diagnosis of Hodgkin lymphoma; it is often used for prognostication and monitoring rather than definitive diagnosis. *Peripheral blood smear* - A **peripheral blood smear** may show non-specific findings such as anemia or leukocytosis, but it does **not typically reveal Reed-Sternberg cells**. - Hodgkin lymphoma is primarily a nodal disease, and its diagnosis relies on lymph node biopsy, not examination of peripheral blood [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. 614-616. [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. 616-618.

Question 1336: Which of the following conditions is associated with elevated leukocyte alkaline phosphatase levels?

A. Pernicious anemia
B. Sickle cell anemia
C. Polycythemia vera (Correct Answer)
D. Plummer-Vinson syndrome

Explanation: ***Polycythemia vera*** - **Leukocyte alkaline phosphatase (LAP)** levels are typically **elevated** in polycythemia vera and other myeloproliferative disorders [1]. [2] - This elevation is due to the increased activity of **mature neutrophils**, which contain the LAP enzyme. *Pernicious anemia* - Pernicious anemia is a **megaloblastic anemia** caused by vitamin B12 deficiency. - It is not typically associated with elevated LAP levels; rather, LAP levels are often **normal or decreased** in certain anemias. *Sickle cell anemia* - Sickle cell anemia is a **hemolytic anemia** characterized by abnormal hemoglobin. - While patients can have elevated WBC counts during crises, LAP levels are generally **normal or decreased** and not a diagnostic feature. *Plummer Vinson syndrome* - Plummer-Vinson syndrome is characterized by **iron deficiency anemia**, dysphagia due to esophageal webs, and glossitis. - LAP levels are not typically affected by this condition and are usually **normal**. **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, pp. 626-627.

Question 1337: Which immunohistochemical markers assist in the diagnosis of follicular lymphoma?

A. CD10 and BCL2 (Correct Answer)
B. CD20 and CD23
C. CD30 and CD15
D. CD3 and CD7

Explanation: ***CD10 and BCL2*** - These markers are crucial in follicular lymphoma, with **CD10** indicating germinal center origin [2][3] and **BCL2** demonstrating the anti-apoptotic effect that contributes to neoplastic proliferation [1][2][3]. - The presence of both these markers is commonly used to characterize **follicular lymphoma**, distinguishing it from other lymphomas [1]. *CD30 and CD15* - These markers are typically associated with **Reed-Sternberg cells** in **Hodgkin lymphoma**, not follicular lymphoma. - Their presence indicates different **malignant lymphoproliferative disorders** unrelated to follicular lymphoma. *CD20 and CD23* - While CD20 is a pan B-cell marker found in many B-cell neoplasms, CD23 is more indicative of **chronic lymphocytic leukemia (CLL)** and not specific to follicular lymphoma. - They do not combine the critical features needed to diagnose follicular lymphoma effectively. *CD3 and CD7* - These are T-cell markers and do not apply to follicular lymphoma, which is a B-cell neoplasm [2][3]. - Their presence indicates T-cell malignancies rather than the **germinal center B-cell** derivation typical of follicular lymphoma [2][3]. **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. 604. [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. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 561-562.

Question 1338: A 5-year-old child presents with fatigue, petechiae, and hepatosplenomegaly. Laboratory results show low hemoglobin, low platelets, and high white blood cell count. The peripheral smear reveals blasts with Auer rods. What is the diagnosis?

A. Acute lymphoblastic leukemia
B. Acute myeloid leukemia (Correct Answer)
C. Chronic lymphocytic leukemia
D. Chronic myeloid leukemia

Explanation: ***Acute myeloid leukemia*** - The presence of **blasts with Auer rods** is characteristic of acute myeloid leukemia [1], which fits the laboratory findings of **low hemoglobin** and **low platelets**. - Symptoms like **fatigue**, **petechiae**, and **hepatosplenomegaly** further support this diagnosis, indicating bone marrow infiltration [1]. *Chronic myeloid leukemia* - Typically presents in older adults and is characterized by the presence of **Philadelphia chromosome** and elevated **white blood cell count** with a predominance of mature cells rather than blasts. - Fatigue and splenomegaly may occur but are not common in a child this young at the acute presentation. *Acute lymphoblastic leukemia* - Generally affects young children [2] but is characterized by **lymphoblasts** on the peripheral smear, rather than **myeloid blasts with Auer rods**. - Usually presents with a **high white blood cell count**, but symptoms differ as lymphoid infiltration is predominant. *Chronic lymphocytic leukemia* - Rarely seen in children; it typically involves an **overproduction of mature lymphocytes** and chronic lymphadenopathy rather than acute symptoms like **petechiae** or **fatigue**. - Associated with **elevated white blood cell count** with a predominance of mature lymphocytes and chronic presentations, contrasting with the acute nature of 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, pp. 621-622. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 607-608.

Question 1339: A patient has recurrent infections and albinism. Examination reveals giant granules in neutrophils. Which genetic disorder is most likely?

A. Chediak-Higashi syndrome (Correct Answer)
B. Chronic granulomatous disease
C. Leukocyte adhesion deficiency
D. Wiskott-Aldrich syndrome

Explanation: ***Chediak-Higashi syndrome*** [1] - Characterized by **albinism**, recurrent infections, and the presence of **giant granules** in leukocytes, particularly neutrophils [1]. - Caused by a mutation in the **LYST gene**, leading to defective lysosomal trafficking. *Chronic granulomatous disease* - Primarily associated with **increased susceptibility to catalase-positive organisms**, but does not present with albinism. - Diagnosis is confirmed by the **nitroblue tetrazolium test**, which shows normal granulation in neutrophils. *Wiskott-Aldrich syndrome* - Features include **eczema**, recurrent infections, and **thrombocytopenia**, but lacks the giant granules seen in Chediak-Higashi syndrome. - It involves a mutation in the **WASP gene**, not linked to albinism. *Leukocyte adhesion deficiency* - Presents with recurrent infections due to **impaired leukocyte migration**, but does not feature giant granules or albinism. - The underlying defect is in the **integrins**, which is not associated with the classic findings of Chediak-Higashi syndrome. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of the Immune System, pp. 245-246.

Question 1340: Which formula is essential for calculating the corrected reticulocyte count in an anemic patient?

A. (Reticulocyte count × Hematocrit) / 45 (Correct Answer)
B. (Reticulocyte count × Hematocrit) / 50
C. (Reticulocyte count × Hematocrit) / 40
D. (Reticulocyte count × Hematocrit) / 30

Explanation: **(Reticulocyte count × Hematocrit) / 45** - This formula is used to calculate the **corrected reticulocyte count (CRC)**, which adjusts the observed reticulocyte percentage for the degree of **anemia**. - The value **'45' represents the normal hematocrit percentage** used as the standard for comparison [1]. * (Reticulocyte count × Hematocrit) / 50* - This formula uses an **incorrect normal hematocrit value** of 50%, which is typically higher than the average normal hematocrit for most adults. - Using an inaccurate reference hematocrit value would lead to an **overestimation of the corrected reticulocyte count**. * (Reticulocyte count × Hematocrit) / 40* - This formula uses an **incorrect normal hematocrit value** of 40%, which is generally on the lower end of the normal range or slightly below for adult males. - This could potentially **overestimate the bone marrow's reticulocyte production** in anemic individuals, depending on the patient's actual normal hematocrit level. * (Reticulocyte count × Hematocrit) / 30* - This formula uses a value of **30% as the normal hematocrit**, which is significantly lower than the accepted normal range. - Using such a low reference value would lead to a **substantial overestimation of the corrected reticulocyte count**, potentially misleading the assessment of erythropoietic activity. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 577-578.

Practice by Chapter

Anemias: Classification and Approach

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Hemolytic Anemias

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Myeloproliferative Neoplasms

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Myelodysplastic Syndromes

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Acute Leukemias

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Chronic Leukemias

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Lymphomas and Lymphoid Neoplasms

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Plasma Cell Disorders

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Bleeding Disorders

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Thrombotic Disorders

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