Hematopathology — MCQs

Hematopathology Indian Medical PG Practice Questions and MCQs

Question 1371: Which marker is commonly associated with positivity in follicular lymphoma?

A. Bcl-1
B. Bcl-6
C. Bcl-2 (Correct Answer)
D. None of the options

Explanation: ***Bcl-2*** - **Follicular lymphoma** is characterized by the overexpression of the **Bcl-2 protein**, which inhibits apoptosis, leading to the survival of malignant B cells [1][3]. - The **Bcl-2 gene** is often involved in the **t(14;18)** chromosomal translocation, which is a hallmark of this lymphoma [1][3][4]. *Bcl-6* - Although **Bcl-6** can be expressed in some lymphomas, it is primarily associated with **diffuse large B-cell lymphoma**, not follicular lymphoma. - **Bcl-6** is involved in **germinal center formation** and its positivity does not indicate follicular lymphoma specifically. *Bcl-1* - **Bcl-1** (also known as **CCND1**) is primarily associated with **mantle cell lymphoma** and is not a characteristic marker for follicular lymphoma. - It is linked to the **t(11;14)** translocation, which is distinct from the genetic alterations seen in follicular lymphoma. *None of the above* - This option is incorrect as **Bcl-2 positivity** is definitive for follicular lymphoma [2]. - The presence of other markers like **Bcl-6** or **Bcl-1** does not negate the expression of Bcl-2 in this lymphoma type. **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. 602-604. [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, p. 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. [4] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, pp. 310-311.

Question 1372: Factor V Leiden thrombophilia is caused by mutation in which of the following factors?

A. Factor V (Leiden mutation) (Correct Answer)
B. Factor X
C. Factor VII
D. Factor IX

Explanation: ***Factor V*** - Leiden thrombophilia is specifically caused by a **mutation in the Factor V gene**, leading to resistance to activated protein C [1]. - This results in an increased risk of **venous thromboembolism** due to uncontrolled coagulation [1]. *Factor X* - Factor X is crucial for the coagulation cascade but is **not implicated in Leiden thrombophilia**; it does not involve a mutation. - Deficiencies or dysfunctions in Factor X lead to different bleeding disorders rather than thrombophilia. *Factor VII* - Factor VII deficiency typically results in **hemorrhagic conditions**, and does not relate to the **thrombotic risks** of Leiden thrombophilia. - It involves **extrinsic pathway coagulation**, which is distinct from the resistance seen in Factor V Leiden. *Factor IX* - Factor IX is associated with **Hemophilia B** and does not play a role in Leiden thrombophilia. - Its mutation results in bleeding tendencies, contrasting with the **thrombotic risk** of Leiden thrombophilia. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Hemodynamic Disorders, Thromboembolic Disease, and Shock, pp. 133-134.

Question 1373: Which of the following is an example of an intracorpuscular defect causing hemolysis?

A. Paroxysmal nocturnal hemoglobinuria (PNH) (Correct Answer)
B. Toxins in uremia
C. Paroxysmal Cold Hemoglobinuria
D. Mechanical trauma in portal hypertension

Explanation: ***PNH*** - **Paroxysmal Nocturnal Hemoglobinuria (PNH)** is caused by a deficiency of glycosylphosphatidylinositol (GPI) anchors, leading to **intracorpuscular defects** in red blood cells [1]. - It results in **hemolysis**, mainly due to increased complement-mediated lysis and associated symptoms like **hemoglobinuria** and dark urine upon waking [1]. *Portal hypertension* - Portal hypertension primarily affects the **portal venous system** and is not directly related to **intracorpuscular defects** in hemolysis. - It can lead to **splenomegaly** and subsequent sequestration of blood cells but does not cause intrinsic RBC defects. *PCH* - **Paroxysmal Cold Hemoglobinuria (PCH)** involves hemolysis due to exposure to cold and is associated with **IgG antibodies** against RBCs, but it's not an **intracorpuscular** defect. - PCH is characterized by hemolysis occurring in response to cold temperatures, rather than an intrinsic defect within the RBCs themselves. *Uremic syndrome* - Uremic syndrome arises due to **kidney failure**, leading to a buildup of waste products and a distinct form of **extracorpuscular hemolysis**, not intracorpuscular defects. - While it can cause anemia, it does not directly involve intrinsic RBC abnormalities like those seen in PNH. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 650-651. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 642-643. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 597-598.

Question 1374: Which of the following statements about cross-matching of blood is false?

A. Mandatory in all cases except emergency
B. Involves visible agglutination
C. Recipient serum is tested against donor packed cells
D. Donor serum is tested against recipient packed cells (Correct Answer)

Explanation: ***Donor serum is tested against recipient packed cells*** - This statement is **FALSE** and describes a **minor crossmatch**, which is rarely performed in modern transfusion practice. - The minor crossmatch tests donor antibodies against recipient cells, but this is not standard practice because donor plasma is significantly diluted during transfusion, making clinically significant reactions rare. - Modern blood banking focuses on the **major crossmatch** as the critical safety measure. *Recipient serum is tested against donor packed cells* - This statement is **TRUE** and accurately describes the **major crossmatch**, which is the standard and most critical pre-transfusion compatibility test. - The major crossmatch detects antibodies in the recipient's serum that could react with donor red blood cell antigens, preventing potentially fatal hemolytic transfusion reactions. *Mandatory in all cases except emergency* - This statement is **TRUE**. Crossmatching is mandatory for safe transfusion practice. - In life-threatening emergencies where delay could be fatal, uncrossmatched O-negative (universal donor) blood may be given, but this is a rare exception. *Involves visible agglutination* - This statement is **TRUE**. A positive crossmatch indicating incompatibility is identified by **visible agglutination** or **hemolysis**. - These visible reactions occur when recipient antibodies bind to donor red blood cell antigens, signaling that transfusion would cause a severe reaction.

Question 1375: Which type of anemia is most commonly characterized by marked poikilocytosis and anisocytosis on peripheral blood smear?

A. Megaloblastic anemia
B. Iron deficiency anemia (Correct Answer)
C. Nutritional anemia
D. Thalassemia

Explanation: ***Iron deficiency anaemia*** - Characterized by **poikilocytosis** (abnormal shapes) and **anisocytosis** (variation in red blood cell sizes), which are common findings in iron deficiency [1]. - Typically results in **microcytic hypochromic anemia** [1], distinguishing it from other types of anemia. *Nutritional deficiency anaemia* - May present with various blood cell morphology but does not specifically exhibit **poikilocytosis** and **anisocytosis** characteristic of iron deficiency anemia. - Usually includes deficiencies like **vitamin B12** or **folate**, which result in **macrocytic anemia** instead. *Megaloblastic anaemia* - Primarily caused by deficiency of **vitamin B12** or **folate**, leading to large, immature red blood cells (megaloblasts) rather than varied shapes and sizes. - Associated with **hypersegmented neutrophils** in the blood smear, which differentiates it from iron deficiency anemia. *Thalassemia* - Characterized by **microcytic hypochromic red blood cells** and often involves **target cells** rather than generalized poikilocytosis and anisocytosis. - Typically presents with **hemolytic anemia** but does not show the same variability in cell shapes and sizes as seen in iron deficiency anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Question 1376: Which of the following is typically expected in a case of Microcytic Hypochromic anemia?

A. Normal Ferritin levels
B. Reduced serum Iron (Correct Answer)
C. Increased TIBC
D. Increased total RBC distribution width

Explanation: ***Reduced total RBC distribution width*** - Microcytic hypochromic anemia typically shows **increased RBC distribution width (RDW)** due to varied sizes of red blood cells, indicating a diverse population in response to microcytic anemia [1]. - A **reduced RDW** would suggest a more uniform red blood cell population, which is not characteristic of this type of anemia. *Normal Ferritin levels* - Ferritin levels are usually **low** in microcytic hypochromic anemia, indicating **iron deficiency** [1]. - Normal ferritin might suggest other types of anemia rather than the iron deficiency expected in microcytic anemia. *Reduced serum Iron* - Serum iron is generally **low** in microcytic hypochromic anemia due to **iron deficiency**, making this an expected finding [1]. - The presence of reduced serum iron supports the diagnosis and is not inconsistent with this type of anemia. *Increased TIBC* - TIBC (Total Iron Binding Capacity) is typically **increased** in microcytic anemia due to low iron stores, reflecting the body's attempt to maximize iron uptake. - An increased TIBC aligns with iron deficiency anemia, which is a common cause of microcytic hypochromic anemia [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Question 1377: The Ham test is specifically used for diagnosing paroxysmal nocturnal hemoglobinuria (PNH) and is based upon:

A. GPI Anchor Proteins
B. Complement (Correct Answer)
C. Spectrin protein
D. Mannose binding proteins

Explanation: ***Complement*** - The HAM test is based on the activation of the **complement system** which enhances the opsonization and clearance of immune complexes [1]. - It is used in the diagnosis of certain conditions, notably those associated with **hemolytic anemia** due to complement fixation. *GPI Anchor Proteins* - GPI anchor proteins are involved in anchoring proteins to cell membranes but are **not related to the HAM test**. - This oes not explain the **mechanism** or purpose of the HAM test. *Mannose binding proteins* - Mannose binding lectins play a role in **innate immunity** but are not the basis of the HAM test. - They function in the **opsonization of pathogens**, which is unrelated to the complement activation aspect of the HAM test. *Spectrin protein* - Spectrin is a cytoskeletal protein that contributes to the integrity of cell membranes, particularly in red blood cells. - It does not relate to the **mechanism of the HAM test**, which focuses on complement involvement. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Inflammation and Repair, pp. 99-100.

Question 1378: Indirect Coombs test detects:

A. Antibodies in the serum (Correct Answer)
B. Antibodies bound to RBC Surface
C. Antigens bound to RBC Surface
D. Antigens in the plasma

Explanation: ***Antibodies in the serum*** - The **indirect Coomb's test** is designed to detect the presence of **antibodies** against red blood cells (RBCs in the serum) before transfusion or during pregnancy [1]. - It is crucial in identifying **hemolytic disease of the newborn** (HDN) and ensuring safe blood transfusions [1]. *Antibodies attached to RBC Surface* - This scenario describes the **direct Coomb's test**, which identifies antibodies that are already bound to **RBCs**. - Direct testing assesses conditions like **autoimmune hemolytic anemia**, not the serum. *Antigens attached to RBC Surface* - This option suggests evaluating **antigens** present on the surface of RBCs, which is not the purpose of the indirect Coomb's test. - Antigens are important in blood typing and compatibility assessments, but this test focuses on antibodies. *Antigens in the serum* - Indirect Coomb's does not detect **antigens** but rather the **antibodies** related to those antigens. - Additionally, serum testing for antigens is not a standard procedure for assessing transfusion compatibility. **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 1379: What is a distinguishing feature of reticulocytes?

A. Slightly larger in size than RBCs
B. Presence of residual RNA and ribosomes (Correct Answer)
C. Mature in bone marrow
D. Constitute approximately 1% of the red cells

Explanation: ***Presence of residual RNA and ribosomes*** - This is the **defining and most distinguishing feature** of reticulocytes that differentiates them from mature red blood cells. - Reticulocytes contain residual **ribosomal RNA** and other organelles that are lost when they mature into erythrocytes. - This residual RNA forms a **reticular (network-like) pattern** when stained with supravital stains like **new methylene blue** or **brilliant cresyl blue**, which is the basis for their name and identification. - The presence of RNA allows for **reticulocyte counting**, an important marker of bone marrow erythropoietic activity. *Slightly larger in size than RBCs* - While reticulocytes may be slightly larger (polychromatophilic appearance), size variation is **not specific** and overlaps significantly with mature RBCs. - Size is not a reliable distinguishing feature and is not used for identification or counting. *Mature in bone marrow* - Reticulocytes are **released from the bone marrow** as immature red cells and complete their maturation in the **peripheral circulation** over 24-48 hours. - They do not fully mature in the bone marrow; their presence in peripheral blood is normal. *Constitute approximately 1% of the red cells* - Normal reticulocyte count is **0.5-2%** (or approximately 1%) of total red blood cells in healthy adults. - This is a **population characteristic** indicating normal erythropoietic activity, not a distinguishing cellular feature.

Question 1380: Which antigen is tested in routine Rh typing?

A. C antigen
B. D antigen (Correct Answer)
C. A antigen
D. B antigen

Explanation: ***D antigen*** - Routine Rh typing specifically tests for the **D antigen**, which determines the Rh status of an individual as Rh-positive or Rh-negative [1]. - The presence of the **D antigen** is crucial for blood transfusions and pregnancy management [1]. *A antigen* - The **A antigen** is tested in the context of the ABO blood group system, not specifically for Rh typing. - It does not provide information regarding the Rh factor which is critical in blood compatibility. *C antigen* - Similar to the **A antigen**, the **C antigen** is part of the broader Rh system but is not routinely assessed in standard Rh typing. - Its testing is typically reserved for specific clinical scenarios involving Rh incompatibility. *B antigen* - The **B antigen** pertains to the ABO blood group and does not relate to the Rh factor or routine Rh typing. - Rh typing is solely focused on the **presence of the D antigen** to determine the Rh status. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628.

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Thrombotic Disorders

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