Hematopathology Practice Questions

Q: What is the typical lifespan of transfused platelets?

3-5 days. **Explanation:** The correct answer is **3-5 days (Option C)**. **1. Understanding the Concept:** In a healthy individual, the physiological lifespan of endogenous platelets is approximately **7–10 days**. However, transfused platelets have a significantly shorter survival time. This reduction is due to the "storage lesion"—biochemical and structural changes that occur during collection, processing, and storage at room temperature (20–24°C). Once infused, these platelets are cleared more rapidly by the recipient's reticuloendothelial system. In a stable patient without complications, the expected survival of transfused platelets is typically **3 to 5 days**. **2. Analysis of Incorrect Options:** * **Option A (<24 hours):** This is seen in pathological states of increased consumption or destruction, such as Disseminated Intravascular Coagulation (DIC), ITP, or high-grade fever/sepsis, but it is not the "typical" lifespan. * **Option B (1-3 days):** While survival can be this short in moderately ill patients, 3-5 days is the standard textbook duration for a stable recipient. * **Option D (7-14 days):** This reflects the lifespan of natural, endogenous platelets in a healthy person, not transfused ones. **3. NEET-PG High-Yield Pearls:** * **Storage:** Platelets are stored at **20–24°C (Room Temperature)** with continuous agitation to prevent aggregation and maintain pH. * **Shelf Life:** Due to the risk of bacterial contamination at room temperature, the maximum storage life is only **5 days**. * **Dose Response:** One unit of Random Donor Platelets (RDP) typically increases the platelet count by **5,000–10,000/µL**, whereas one unit of Single Donor Platelets (SDP) increases it by **30,000–60,000/µL**. * **Refractoriness:** If the 1-hour post-transfusion increment is less than expected on two occasions, it suggests platelet refractoriness (often due to HLA alloimmunization).

Q: Which of the following markers are seen in Primary effusion lymphoma?

CD30, CD138. **Primary Effusion Lymphoma (PEL)** is a rare, aggressive B-cell non-Hodgkin lymphoma caused by **Human Herpesvirus-8 (HHV-8)**, typically occurring in HIV-positive or immunocompromised patients [1]. ### **Why Option A is Correct?** PEL has a unique "null" phenotype or a **plasmablastic** immunophenotype. Although it is a B-cell malignancy, it characteristically lacks traditional B-cell markers (like CD19, CD20, and CD79a) [1]. Instead, it expresses markers of terminal B-cell differentiation: * **CD138 (Syndecan-1):** A plasma cell marker consistently expressed in PEL. * **CD30:** Frequently expressed (approx. 70% of cases), reflecting its activated/transformed state. * **Other markers:** EMA (Epithelial Membrane Antigen) and CD45 are often positive. ### **Why Other Options are Incorrect?** * **Options B & C (CD19, CD20):** These are pan-B-cell markers. PEL is defined by the **absence** of these surface markers (downregulated during plasmablastic transformation) [1]. Their presence would point toward other B-cell lymphomas like DLBCL. * **Option D (CD29):** CD29 is an integrin subunit not used as a diagnostic marker for PEL. ### **High-Yield Clinical Pearls for NEET-PG** 1. **Viral Association:** 100% of cases are associated with **HHV-8** (KSHV) [1]. Many are also co-infected with **EBV**. 2. **Clinical Presentation:** Presents as malignant effusions (pleural, pericardial, or peritoneal) **without** a detectable solid tumor mass or lymphadenopathy [1]. 3. **Morphology:** Cells show "plasmablastic" or "immunoblastic" features. 4. **Key Diagnostic Step:** Detection of **LANA-1** (Latent Nuclear Antigen-1) via immunohistochemistry confirms HHV-8 infection. **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. 604-605.

Q: What is the most common lymph node involved in Hodgkin's lymphoma?

Cervical. **Explanation:** **Hodgkin’s Lymphoma (HL)** typically presents as a painless, rubbery enlargement of lymph nodes. The disease characteristically follows a predictable, contiguous pattern of spread through the lymphatic system. **1. Why Cervical is Correct:** The **cervical lymph nodes** (specifically the upper cervical, supraclavicular, or mediastinal groups) are the most common site of involvement, seen in approximately **60-80% of cases** at the time of diagnosis [1]. This predilection is particularly strong in the Nodular Sclerosis and Mixed Cellularity subtypes [1]. The involvement is usually asymmetrical and often starts in the neck before spreading to the mediastinum. **2. Why Other Options are Incorrect:** * **Axillary (C):** While frequently involved, it is less common than cervical nodes (approx. 10-15%). * **Inguinal (A):** Involvement of the inguinal nodes is relatively rare in HL (approx. 6-10%) and is more commonly associated with Non-Hodgkin Lymphoma (NHL) or localized infections/malignancies of the lower extremities and pelvis. * **Sub-clavicular (D):** While supraclavicular nodes are common, "sub-clavicular" nodes are not a primary or most frequent site of presentation compared to the cervical chain. **Clinical Pearls for NEET-PG:** * **Bimodal Age Distribution:** HL shows two peaks—one in the 20s and another after age 50. * **Reed-Sternberg (RS) Cells:** The diagnostic hallmark (e.g., "Owl’s eye" appearance) [1]. * **Alcohol-Induced Pain:** A classic, high-yield clinical sign where pain occurs in the involved lymph nodes after alcohol consumption. * **Staging:** The **Ann Arbor Staging System** is used, and the presence of "B symptoms" (fever, night sweats, weight loss) indicates a worse prognosis [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. 616-618.

Q: Which of the following statements regarding Myelodysplasia is FALSE?

Patients with 5q deletion have a poor prognosis.. **Explanation:** **1. Why Option A is the Correct (False) Statement:** In Myelodysplastic Syndromes (MDS), the **5q deletion (5q- syndrome)** is actually associated with a **favorable prognosis** [1]. It typically occurs in elderly females and is characterized by severe macrocytic anemia, a normal or elevated platelet count, and a low risk of transformation to Acute Myeloid Leukemia (AML) [1]. These patients show an excellent therapeutic response to **Lenalidomide**. **2. Analysis of Other Options (True Statements):** * **Option B:** Dyserythropoiesis in MDS often manifests as **basophilic stippling**, ring sideroblasts, and nuclear budding/fragmentation [1]. * **Option C:** Dysmegakaryopoiesis is a hallmark of MDS. **Micromegakaryocytes** (Pawn ball megakaryocytes) with small, non-lobulated nuclei are classic bone marrow findings [1]. * **Option D:** Dysgranulopoiesis leads to the formation of **Pseudo-Pelger-Huët cells**, which are hyposegmented (bilobed or peanut-shaped) and hypogranular neutrophils seen in the peripheral blood [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Definition:** MDS is a clonal stem cell disorder characterized by "Ineffective Hematopoiesis" (Hypercellular marrow but peripheral cytopenia) [1]. * **IPSS Score:** Used for prognosis; based on blast percentage, cytogenetics, and number of cytopenias. * **Cytogenetics:** Good prognosis (5q-, 20q-, -Y); Poor prognosis (Complex karyotype, Chromosome 7 abnormalities) [1]. * **Ring Sideroblasts:** Defined as $\geq$ 5 iron granules encircling $\geq$ 1/3rd of the nucleus (Prussian Blue stain). * **Transformation:** MDS can transform into AML if blasts in the marrow reach $\geq$ 20% [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614.

Question 1

A 60-year-old man is referred because of splenomegaly and generalized lymphadenopathy. The total white blood cell count is markedly elevated, and the differential count reveals a preponderance of mature appearing lymphocytes. Bone marrow examination reveals a diffuse infiltration with similar-appearing lymphocytes. Which of the following statements best characterizes this disorder?

Accepted Answer

Bacterial infections are common early in the disease due to hypogammaglobulinemia.

Answer

A progressive increase in the number of myeloblasts and promyelocytes is indicative of acceleration of the disease process.

Answer

Mean survival is less than 1 year after diagnosis.

Answer

Myelofibrosis is a common complication.

Question 2

What is the typical lifespan of transfused platelets?

Accepted Answer

3-5 days

Answer

<24 hours

Answer

1-3 days

Answer

7-14 days

Question 3

Which of the following is a cause for disseminated intravascular coagulation (DIC)?

Accepted Answer

Malignancy

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Lymphoma

Answer

Massive blood transfusion

Question 4

According to WHO, which of the following is not a B cell lymphoma?

Accepted Answer

Anaplastic large cell lymphoma

Answer

Burkitt's lymphoma

Answer

Follicular lymphoma

Answer

Mantle cell lymphoma

Question 5

Which of the following markers are seen in Primary effusion lymphoma?

Accepted Answer

CD30, CD138

Answer

CD20, CD28

Answer

CD19, CD20

Answer

CD29, CD30

Question 6

What is the most common lymph node involved in Hodgkin's lymphoma?

Accepted Answer

Cervical

Answer

Inguinal

Answer

Axillary

Answer

Sub-clavicular

Question 7

Fresh frozen plasma is used in which of the following conditions?

Accepted Answer

Specific clotting factor deficiency

Answer

Acute blood loss

Answer

Nutritive support

Answer

Decreased blood volume

Question 8

On which chromosome is the ABO blood group gene located?

Accepted Answer

Chromosome 9

Answer

Chromosome 1

Answer

Chromosome 3

Answer

Chromosome 6

Question 9

Sezary syndrome is classified under which category?

Accepted Answer

T cell leukemia

Answer

Lymphoma

Answer

B cell leukemia

Answer

Pigmented disorder of skin

Question 10

Which of the following statements regarding Myelodysplasia is FALSE?

Accepted Answer

Patients with 5q deletion have a poor prognosis.

Answer

Erythroid cells with basophilic stippling are seen.

Answer

Micromegakaryocytes are seen in the bone marrow.

Answer

Hypolobulated neutrophils are seen in peripheral blood.

Hematopathology — MCQs

Hematopathology — MCQs

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