Hematopathology Practice Questions

Q: MCV > 100 fL in all of the following except?

Lead poisoning. **Explanation:** The Mean Corpuscular Volume (MCV) measures the average size of red blood cells (RBCs). An MCV > 100 fL indicates **macrocytosis**, while an MCV < 80 fL indicates **microcytosis** [2]. **Why Lead Poisoning is the Correct Answer:** Lead poisoning is a classic cause of **microcytic hypochromic anemia** (MCV < 80 fL). Lead inhibits key enzymes in the heme synthesis pathway, specifically **delta-aminolevulinate dehydratase (ALAD)** and **ferrochelatase**. This inhibition prevents the incorporation of iron into protoporphyrin, resulting in smaller, pale RBCs. Therefore, it does not cause macrocytosis. **Analysis of Incorrect Options:** * **Alcoholic Liver Disease:** Chronic alcohol consumption is a common cause of non-megaloblastic macrocytosis. It occurs due to the direct toxic effect of ethanol on the bone marrow and alterations in the RBC lipid membrane. * **Folate Deficiency:** This leads to **megaloblastic anemia** [3]. Lack of folate impairs DNA synthesis (specifically thymidine production), resulting in nuclear-cytoplasmic dyssynchrony where the cell grows but cannot divide its nucleus properly, leading to very high MCV (>110 fL) [3]. * **Reticulocytosis:** Reticulocytes (immature RBCs) are physically larger than mature erythrocytes. In conditions with high RBC turnover (like hemolysis), a high reticulocyte count will falsely elevate the average MCV. **NEET-PG High-Yield Pearls:** 1. **Basophilic Stippling:** A hallmark of lead poisoning (due to inhibition of pyrimidine 5'-nucleotidase), though also seen in thalassemia [1]. 2. **Burton’s Line:** Bluish-purple line on the gums associated with chronic lead poisoning [4]. 3. **Megaloblastic vs. Non-megaloblastic:** Folate/B12 deficiency shows hypersegmented neutrophils; Alcohol/Hypothyroidism/Liver disease typically do not. 4. **Drug-induced Macrocytosis:** Common culprits include Hydroxyurea, Methotrexate, and Zidovudine.

Q: In a patient with acute leukemia, the immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, and CD 13+ve. What is the probable diagnosis?

Biphenotypic leukemia. ### Explanation **1. Why Biphenotypic Leukemia is Correct:** Biphenotypic Acute Leukemia (BAL), now classified under **Mixed Phenotype Acute Leukemia (MPAL)** by the WHO, occurs when a single population of blasts expresses markers of more than one lineage. In this case, the blasts express **B-lymphoid markers (CD19, CD10)** and **Myeloid markers (CD33, CD13)**. According to the scoring system (EGIL) or WHO criteria, the co-expression of strong lineage-specific markers from two different lineages (B-cell and Myeloid) confirms a mixed phenotype rather than a lineage-restricted leukemia. **2. Why Incorrect Options are Wrong:** * **B. Acute Lymphoblastic Leukemia (ALL):** While CD19 and CD10 are classic B-ALL markers, the significant expression of CD33 and CD13 (myeloid markers) excludes a diagnosis of pure ALL. * **C. AML-M2:** This is a myeloid leukemia characterized by the t(8;21) translocation. While it may occasionally show "lineage infidelity" (like CD19 expression), the presence of strong B-cell markers (CD10/CD19) alongside myeloid markers in a blast population points toward MPAL. * **D. AML-M0:** This is minimally differentiated AML. Blasts are negative for myeloperoxidase (MPO) and typically do not express lymphoid markers like CD10 or CD19. **3. High-Yield Clinical Pearls for NEET-PG:** * **MPAL Definition:** Requires meeting specific criteria for more than one lineage (e.g., MPO for Myeloid; CD19/CD22/CD79a for B-lineage; cytoplasmic CD3 for T-lineage). * **Common Translocations:** MPAL is frequently associated with **t(9;22)** (Philadelphia chromosome) or **MLL gene rearrangements** (11q23). * **Prognosis:** Generally carries a **poorer prognosis** compared to lineage-specific AML or ALL. * **CD10 (CALLA):** A high-yield marker for Common ALL, but its presence alongside myeloid markers is a hallmark of biphenotypic presentation.

Q: What is the preservation solution used for storing blood for transfusion?

CDP-A. **Explanation:** The correct answer is **CPD-A (Citrate Phosphate Dextrose Adenine)**. This is the standard preservative solution used in blood banking to maintain the viability and function of red blood cells (RBCs) during storage. **Why CPD-A is the correct choice:** Each component of CPD-A serves a specific physiological purpose: * **Citrate:** Acts as an anticoagulant by chelating calcium ions, preventing the coagulation cascade. * **Phosphate:** Acts as a buffer to maintain the pH of the blood, preventing excessive acidity during storage. * **Dextrose (Glucose):** Provides a substrate for glycolysis, allowing the RBCs to generate ATP. * **Adenine:** Enhances ATP synthesis, which extends the shelf life of the blood from 21 days (standard CPD) to **35 days**. **Analysis of Incorrect Options:** * **A & B (Heparin/Citrate + Glucose):** While citrate and glucose are components, they lack the buffering capacity of phosphate and the ATP-boosting properties of adenine, leading to a shorter shelf life and poorer cell survival. Heparin is rarely used as it is not a preservative and activates platelets. * **C (EDTA):** While EDTA is an excellent anticoagulant for laboratory hematology (CBC), it is **never** used for transfusion because it damages RBC membranes and is toxic in large systemic doses [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Shelf Life:** CPD-A extends storage to **35 days**. If SAGM (Saline-Adenine-Glucose-Mannitol) is added, storage extends to **42 days**. * **Storage Temperature:** Whole blood/RBCs must be stored at **2°C to 6°C**. * **Storage Lesion:** During storage, there is a decrease in 2,3-DPG (shifting the oxygen dissociation curve to the left) and an increase in extracellular Potassium (risk of hyperkalemia in neonates/massive transfusions).

Question 1

In sickle cell anemia, which of the following is true?

Accepted Answer

Autosplenectomy due to thrombosis and infarction

Answer

Microcytosis

Answer

Microcardia

Answer

Splenomegaly

Question 2

What is the most common variant of lymphoma seen in HIV-positive patients?

Accepted Answer

Immunoblastic Lymphoma

Answer

Burkitt's Lymphoma

Answer

Primary CNS Lymphoma

Answer

Mantle Cell Lymphoma

Question 3

MCV > 100 fL in all of the following except?

Accepted Answer

Lead poisoning

Answer

Alcoholic liver disease

Answer

Folate deficiency

Answer

Reticulocytosis

Question 4

In a patient with acute leukemia, the immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, and CD 13+ve. What is the probable diagnosis?

Accepted Answer

Biphenotypic leukemia

Answer

Acute lymphoblastic leukemia (ALL)

Answer

Acute myeloid leukemia - M2 subtype (AML-M2)

Answer

Acute myeloid leukemia - M0 subtype (AML-M0)

Question 5

Which of the following statements is true about Multiple Myeloma?

Accepted Answer

Monoclonal immunoglobulin (M spike) is increased.

Answer

Plasma cells deposit directly in glomerular capillaries, causing kidney damage.

Answer

Interleukin-8 (IL-8) is a marker for bone lesions.

Answer

Alkaline phosphatase levels are invariably increased.

Question 6

Which of the following findings is not compatible with a diagnosis of juvenile myelomonocytic leukemia?

Accepted Answer

Presence of bcr/abl fusion gene

Answer

Peripheral blood monocytosis, more than 1 x 10^9/L

Answer

Increased hemoglobin F levels for age

Answer

GM-CSF hypersensitivity of myeloid progenitors in vitro

Question 7

Delayed prolonged bleeding after a minor surgery is caused by a defect in which of the following?

Accepted Answer

Secondary hemostasis.

Answer

Primary hemostasis.

Answer

Defect in the capillary bed to support the clot.

Answer

Defect in connective tissue to support capillaries.

Question 8

Which of the following conditions is associated with a BRAF mutation?

Accepted Answer

Hairy cell leukemia

Answer

Langerhans cell histiocytosis (LCH)

Answer

Colon carcinoma

Answer

Acute myeloid leukemia (AML)

Question 9

What is the preservation solution used for storing blood for transfusion?

Accepted Answer

CDP-A

Answer

Heparin + dextrose

Answer

Citrate + glucose

Answer

EDTA

Question 10

All of the following are WHO classified Myelodysplastic Syndromes except:

Accepted Answer

Chronic myeloid leukemia (CML)

Answer

Refractory anemia with excess blasts

Answer

Refractory anemia with ringed sideroblasts

Answer

Refractory anemia

Hematopathology — MCQs

Hematopathology — MCQs

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