Hematopathology Practice Questions

Q: Spot the diagnosis?

Lead poisoning. ***Lead poisoning*** - The peripheral blood smear shows **coarse basophilic stippling** in red blood cells, which is pathognomonic for lead poisoning. - Lead inhibits **5'-nucleotidase** enzyme, causing aggregation of ribosomes and RNA that appear as prominent blue dots on Wright-Giemsa stain. *Macrocytic anemia* - Would present with **enlarged red blood cells** (MCV >100 fL) on peripheral smear, not basophilic stippling. - Commonly caused by **vitamin B12** or **folate deficiency**, showing hypersegmented neutrophils and oval macrocytes. *Howell-Jolly bodies* - Appear as **small, single, round purple inclusions** representing nuclear remnants in red blood cells. - Typically seen in **post-splenectomy** patients or **functional asplenia**, not associated with basophilic stippling. *Heinz bodies* - Are **denatured hemoglobin precipitates** that appear as pale inclusions on supravital stains like crystal violet. - Associated with **G6PD deficiency** or **oxidative stress**, causing hemolytic anemia rather than basophilic stippling.

Q: Peripheral smear may show vacuolated lymphocytes in all of the following conditions EXCEPT?

Abetalipoproteinemia. **Explanation:** The presence of **vacuolated lymphocytes** on a peripheral blood smear is a classic morphological marker for several **lysosomal storage disorders (LSDs)**. These vacuoles represent enlarged lysosomes filled with undigested substrates due to specific enzyme deficiencies [1]. **1. Why Abetalipoproteinemia is the correct answer:** Abetalipoproteinemia is a disorder of lipid metabolism caused by a mutation in the microsomal triglyceride transfer protein (MTP). The hallmark peripheral smear finding in this condition is **Acanthocytes** (spur cells), not vacuolated lymphocytes. Lipid malabsorption occurs, but it does not result in the lysosomal storage patterns seen in the other options. **2. Analysis of incorrect options (Conditions showing vacuolated lymphocytes):** * **Neuronal Ceroid Lipofuscinosis (NCL):** Specifically the juvenile form (Batten disease), which is a high-yield association for vacuolated lymphocytes. * **Fucosidosis and Sialidosis:** These are glycoprotein storage diseases. Along with **Mannosidosis**, they frequently present with prominent cytoplasmic vacuolation in lymphocytes [1]. * *Other notable causes:* Pompe disease, Wolman disease, and Niemann-Pick disease [1]. **Clinical Pearls for NEET-PG:** * **Acanthocytes (Spur Cells):** Think Abetalipoproteinemia, Chronic Liver Disease, or McLeod Syndrome. * **Vacuolated Lymphocytes + Coarse Facies:** Think Mucopolysaccharidosis (MPS) or Glycoproteinosis (Fucosidosis/Sialidosis) [1]. * **Vacuolated Lymphocytes + Cherry Red Spot:** Think Sialidosis or Niemann-Pick Disease [1]. * **Jordan’s Anomaly:** This refers to vacuoles in **neutrophils** (not lymphocytes), typically seen in Chanarin-Dorfman syndrome (a lipid storage disease). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, pp. 161-164.

Question 1

Poikilocytosis is due to difference in:

Accepted Answer

Shape

Answer

Size

Answer

Number

Answer

Width

Question 2

Spot the diagnosis?

Accepted Answer

Lead poisoning

Answer

Macrocytic anemia

Answer

Howell-Jolly bodies

Answer

Heinz bodies

Question 3

A 1-year-old girl presents with a 3-day history of fever and diarrhea. Her temperature is 38°C (101°F). A CBC reveals a normal WBC count and an increased hematocrit of 48 g/dL. What is the most likely cause of the elevated hematocrit in this patient?

Accepted Answer

Dehydration

Answer

Acute phase response

Answer

Diabetes insipidus

Answer

Malabsorption

Question 4

Which statement is false regarding hemolytic anemia?

Accepted Answer

Decreased lactate dehydrogenase (LDH)

Answer

Decreased haptoglobin

Answer

Decreased red blood cell survival

Answer

Increased unconjugated bilirubin

Question 5

All of the following are preleukemic conditions, except:

Accepted Answer

Paroxysmal Cold Haemoglobinuria (PCH)

Answer

Paroxysmal Nocturnal Haemoglobinuria (PNH)

Answer

Myelodysplasia

Answer

Aplastic anemia

Question 6

Basophilic stippling is seen with which of the following conditions?

Accepted Answer

Thalassaemia

Answer

Sickle cell anemia

Answer

Megaloblastic anemia

Answer

Splenectomy

Question 7

Which of the following is a consequence of extravascular hemolysis?

Accepted Answer

Jaundice

Answer

Hemoglobinemia

Answer

Hemosiderinuria

Answer

All of the above

Question 8

Peripheral smear may show vacuolated lymphocytes in all of the following conditions EXCEPT?

Accepted Answer

Abetalipoproteinemia

Answer

Neuronal ceroid lipofuscinosis

Answer

Fucosidosis

Answer

Sialidosis

Question 9

Which immunoglobulin is typically implicated as a warm antibody in autoimmune hemolytic anemia?

Accepted Answer

IgG

Answer

IgM

Answer

IgE

Answer

IgA

Question 10

Which type of leukemia is associated with Disseminated Intravascular Coagulation?

Accepted Answer

Acute promyelocytic leukemia

Answer

Acute lymphocytic leukemia

Answer

Chronic myeloid leukemia

Answer

Chronic lymphoid leukemia

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?