Hematopathology Practice Questions

Q: What is the term for a dilated endoplasmic reticulum?

Dohle bodies. **Explanation:** **Dohle bodies** are the correct answer. They are light blue-gray, oval, or teardrop-shaped inclusions found in the cytoplasm of neutrophils. Ultrastructurally, they represent **dilated strands of rough endoplasmic reticulum (RER)**. They are typically seen in "toxic" states such as severe bacterial infections, burns, trauma, or pregnancy, often alongside toxic granulation and cytoplasmic vacuolation. **Analysis of Incorrect Options:** * **Asteroid bodies:** These are star-shaped eosinophilic inclusions found within giant cells in granulomatous diseases, most classically **Sarcoidosis** and Sporotrichosis. * **Bamboo bodies:** These are ferruginous bodies (asbestos bodies) that appear segmented or beaded, resembling bamboo. They are found in the lungs of patients with **Asbestosis**. * **Hirano bodies:** These are eosinophilic, rod-like inclusions made of actin-binding proteins found in the neurons (specifically the hippocampus) of patients with **Alzheimer’s disease**. **High-Yield Clinical Pearls for NEET-PG:** * **May-Hegglin Anomaly:** This is a rare autosomal dominant disorder characterized by large, "Dohle-like" bodies in leukocytes, associated with giant platelets and thrombocytopenia. * **Toxic Granulation:** Often seen with Dohle bodies, these represent prominent primary granules (lysosomes) in neutrophils during inflammation. * **Chediak-Higashi Syndrome:** Characterized by giant lysosomal granules in neutrophils (due to a defect in vesicle trafficking), which should not be confused with Dohle bodies.

Q: Reduced platelet count is found in all the conditions except:

Von Willebrand disease. **Explanation:** The correct answer is **Von Willebrand disease (vWD)** because it is primarily a **qualitative platelet disorder** (defect in platelet adhesion) rather than a quantitative one [1]. In most types of vWD (Type 1 and Type 2), the platelet count remains **normal**. The pathology lies in the deficiency or dysfunction of Von Willebrand Factor (vWF), which acts as a bridge between platelets and the subendothelial collagen [3]. **Analysis of Options:** * **Disseminated Intravascular Coagulation (DIC):** Characterized by widespread activation of the coagulation cascade, leading to the **consumption** of platelets and clotting factors [2]. Thrombocytopenia is a hallmark finding. * **Aplastic Anemia:** A bone marrow failure syndrome where there is peripheral pancytopenia due to marrow hypoplasia. Reduced production leads to a **low platelet count**. * **Acute Myelocytic Leukemia (AML):** Malignant proliferation of blast cells in the bone marrow "crowds out" normal hematopoiesis (myelophthisic effect), resulting in **decreased production** of mature platelets. **High-Yield Clinical Pearls for NEET-PG:** * **Exception in vWD:** **Type 2B vWD** is a unique variant where "gain-of-function" mutations cause increased binding of vWF to platelets, leading to their clearance and **mild thrombocytopenia** [2]. However, as a general rule for exams, vWD presents with a normal platelet count. * **Lab Findings in vWD:** Increased Bleeding Time (BT), normal or increased aPTT (due to low Factor VIII levels), and **abnormal Ristocetin cofactor assay** (the gold standard for diagnosis) [3]. * **Treatment of Choice:** Desmopressin (DDAVP) for Type 1; vWF concentrate for Type 3 [3].

Q: Dohle bodies can be seen in which of the following conditions?

Sepsis. **Explanation:** **Dohle bodies** are small, light blue-grey, oval inclusions found in the periphery of the cytoplasm of **neutrophils**. They represent remnants of **rough endoplasmic reticulum (RER)** arranged in parallel rows. **Why Sepsis is Correct:** Dohle bodies are a hallmark of **toxic granulation** and "left shift" seen in states of intense inflammation or cytokine stress. In **sepsis** (or severe bacterial infections), there is accelerated granulopoiesis. The rapid maturation of neutrophils in the bone marrow leads to defects in cytoplasmic maturation, causing fragments of RER to persist in the mature cell. They are frequently seen alongside toxic granules and cytoplasmic vacuoles. **Analysis of Incorrect Options:** * **Plasma cell myeloma:** This is a malignancy of plasma cells characterized by Russell bodies (intracellular Ig) or Mott cells, not neutrophil inclusions. * **Chronic granulomatous disease (CGD):** This is a functional defect of the NADPH oxidase enzyme. Neutrophils appear morphologically normal under light microscopy but fail the Nitroblue Tetrazolium (NBT) test. * **Rheumatoid arthritis:** While a chronic inflammatory state, it does not typically manifest with Dohle bodies unless there is a concurrent acute systemic infection or Felty’s syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Composition:** Dohle bodies consist of **Ribosomal RNA/Rough ER**. * **Differential Diagnosis:** Apart from sepsis/infection, they are classically seen in **May-Hegglin Anomaly** (associated with giant platelets and thrombocytopenia), burns, and normal pregnancy. * **Stain:** They are best visualized using **Romanowsky stains** (Leishman or Giemsa). * **Toxic Triad:** In severe infection, look for the triad of **Dohle bodies, Toxic granulations, and Cytoplasmic vacuolation** in neutrophils.

Question 1

Eosinophilic granuloma results from the proliferation of which cell type?

Accepted Answer

Histiocytes

Answer

Eosinophils

Answer

Lymphocytes

Answer

Fibroblasts

Question 2

During a routine blood test among members of a family, abnormally high potassium values were noted. Which hematological anomaly is known to cause such a finding?

Accepted Answer

Hereditary elliptocytosis

Answer

Idiopathic Thrombocytopenic Purpura (ITP)

Answer

Polycythemia rubra vera

Answer

Bernard-Soulier syndrome

Question 3

What is the term for a dilated endoplasmic reticulum?

Accepted Answer

Dohle bodies

Answer

Asteroid bodies

Answer

Bamboo bodies

Answer

Hirano bodies

Question 4

Deficiency of all three components of coagulation factor VIII results in which of the following conditions?

Accepted Answer

Von Willebrand's disease

Answer

Hemophilia A

Answer

Parahemophilia

Answer

Hemophilia B

Question 5

A 32-year-old asymptomatic female, not requiring blood transfusion, presents with Hb 13.0 gm/dl. Her HbF levels are 95% and Hb A2 levels are 1.5%. Which of the following is the most likely diagnosis?

Accepted Answer

Hereditary persistence of fetal hemoglobin

Answer

Beta homozygous thalassemia

Answer

Thalassemia intermedia

Answer

Beta heterozygous thalassemia

Question 6

Reduced platelet count is found in all the conditions except:

Accepted Answer

Von Willebrand disease

Answer

Disseminated intravascular coagulation

Answer

Aplastic anemia

Answer

Acute myelocytic leukemia

Question 7

Bence Jones proteins are found in all of the following conditions except?

Accepted Answer

Reactive plasmacytosis

Answer

Multiple myeloma

Answer

Monoclonal gammopathy of undetermined significance

Answer

Waldenstroms macroglobulinemia

Question 8

Which among the following is not a feature of follicular lymphoma?

Accepted Answer

(11;14) translocation

Answer

BCL2 over expression

Answer

BCL6 rearrangement

Answer

CD5 negative

Question 9

All are examples of microangiopathic hemolytic anemia except?

Accepted Answer

Immune thrombocytopenic purpura (ITP)

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Hemolytic uremic syndrome (HUS)

Answer

Disseminated intravascular coagulation (DIC)

Question 10

Dohle bodies can be seen in which of the following conditions?

Accepted Answer

Sepsis

Answer

Plasma cell myeloma

Answer

Chronic granulomatous disease

Answer

Rheumatoid arthritis

Hematopathology — MCQs

Hematopathology — MCQs

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