Hematopathology Practice Questions

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.

Q: All of the following are present in cryoprecipitate, except?

Factor V. ### Explanation **Cryoprecipitate** is the cold-insoluble fraction of plasma obtained by thawing Fresh Frozen Plasma (FFP) at 1–6°C. It is a concentrated source of specific clotting factors, and understanding its composition is high-yield for NEET-PG. **Why Factor V is the correct answer:** Factor V is a **labile clotting factor** that remains in the supernatant (the liquid portion) during the cold-thawing process. It does not precipitate out. Therefore, Factor V is present in Fresh Frozen Plasma (FFP) but is **absent** in cryoprecipitate. **Analysis of Incorrect Options:** * **Factor I (Fibrinogen):** Cryoprecipitate is the primary source of concentrated fibrinogen (approx. 150–250 mg per unit). It is the treatment of choice for hypofibrinogenemia. * **Factor VIII:** It contains significant amounts of Factor VIII (anti-hemophilic factor), making it useful in Hemophilia A if specific concentrates are unavailable. * **Von Willebrand Factor (vWF):** Cryoprecipitate is rich in vWF, which is why it was historically used to treat Von Willebrand Disease. * *Note:* **Factor XIII** (Fibrin Stabilizing Factor) and **Fibronectin** are also present in cryoprecipitate. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Cryoprecipitate contents:** "**1, 8, 13, vWF**" (Factors I, VIII, XIII, and vWF). * **Storage:** Cryoprecipitate is stored at **-18°C or colder** and has a shelf life of 1 year. Once thawed, it must be used within 6 hours. * **Indication:** The most common modern indication is **hypofibrinogenemia** (e.g., in DIC or massive transfusion protocols). * **Factor V deficiency:** Must be treated with **FFP**, as cryoprecipitate does not contain it.

Q: Examination of a lymph node from the neck of a 26-year-old man with bilateral cervical lymphadenopathy reveals total effacement of nodal architecture, and at higher power, the characteristic cell shown below. Which of the following additional studies is best suited for confirmation of diagnosis in this case?

Immunohistochemistry. ***Immunohistochemistry*** - **CD15** and **CD30** positivity is the **gold standard** for confirming **Hodgkin's lymphoma** with **Reed-Sternberg cells**, which show characteristic **owl's eye** appearance with large nucleoli. - **Immunohistochemistry** provides definitive identification of the **Reed-Sternberg cell phenotype** and distinguishes it from other large cell lymphomas through specific marker expression. *Serum protein electrophoresis* - Used primarily to detect **monoclonal gammopathy** and **multiple myeloma** through identification of **M-protein** spikes. - Not specific for **lymphoma diagnosis** and cannot identify the characteristic **Reed-Sternberg cell** markers needed for Hodgkin's lymphoma confirmation. *Flow cytometry* - **Reed-Sternberg cells** are typically **too large** and **fragile** to be effectively analyzed by flow cytometry, often getting lost during sample preparation. - More suitable for **B-cell** and **T-cell lymphomas** where smaller, intact lymphocytes can be analyzed for surface markers. *Gene rearrangement studies* - Primarily used to detect **clonal B-cell** or **T-cell populations** in **non-Hodgkin lymphomas** through **immunoglobulin** or **T-cell receptor** gene rearrangements. - **Hodgkin's lymphoma** diagnosis relies on **morphology** and **immunophenotype** rather than specific gene rearrangement patterns.

Q: Smudge cells are characteristic findings in which of the following hematological malignancies?

Chronic lymphocytic leukemia. **Explanation:** **Chronic Lymphocytic Leukemia (CLL)** is the correct answer. Smudge cells (also known as **Basket cells**) are remnants of fragile, mature-appearing small lymphocytes that rupture during the preparation of a peripheral blood smear [1]. In CLL, the neoplastic B-cells have an altered cytoskeleton, making them mechanically delicate. While not pathognomonic, the presence of numerous smudge cells in an elderly patient with absolute lymphocytosis is a classic diagnostic hallmark of CLL/SLL [1]. **Analysis of Incorrect Options:** * **Nodular Sclerosis Hodgkin’s Lymphoma:** Characterized by **Lacunar cells** (RS cell variants) and collagen bands. Smudge cells are not a feature. * **Lymphocyte Predominant Hodgkin’s Lymphoma:** Characterized by **"Popcorn cells"** (L&H cells) which express B-cell markers like CD20. * **Sezary Syndrome:** A cutaneous T-cell lymphoma characterized by **Sezary cells**, which are atypical lymphocytes with **cerebriform nuclei** (grooved, brain-like appearance). **High-Yield Clinical Pearls for NEET-PG:** * **The "Smudge Cell" Hack:** Adding a drop of **bovine albumin** to the blood sample before spreading the film can prevent the formation of smudge cells, allowing for better visualization of nuclear morphology. * **Immunophenotype of CLL:** Characteristically positive for **CD5** (a T-cell marker), **CD19, CD20, and CD23** [1]. It shows weak expression of surface immunoglobulins (sIg). * **Prognostic Marker:** High levels of **ZAP-70** or **CD38** expression and **17p deletion** (TP53 mutation) indicate a poor prognosis in CLL. **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, p. 602.

Q: Which blood index most accurately reflects iron deficiency?

MCHC. **Explanation:** In Iron Deficiency Anemia (IDA), the primary defect is a decrease in hemoglobin synthesis. **MCHC (Mean Corpuscular Hemoglobin Concentration)** is the most accurate index for iron deficiency because it measures the concentration of hemoglobin in a given volume of packed red cells. As iron stores deplete, hemoglobin production falls significantly relative to the cell size, leading to **hypochromia**. A low MCHC is the hallmark of true hypochromic anemia. **Analysis of Options:** * **MCV (Mean Corpuscular Volume):** Reflects the average size of RBCs. While MCV decreases in IDA (microcytosis), it is also low in other conditions like Thalassemia trait, Anemia of Chronic Disease, and Sideroblastic anemia [1]. It is a sensitive but less specific indicator of iron status compared to MCHC. * **MCH (Mean Corpuscular Hemoglobin):** Measures the average weight of hemoglobin per RBC. Since MCH is mathematically dependent on the cell size (MCV), it often mirrors MCV and is less reliable as an isolated measure of hemoglobin concentration. * **PCV (Packed Cell Volume):** Also known as Hematocrit, it reflects the proportion of blood occupied by RBCs. It is used to screen for anemia in general but does not provide specific information about the morphological type or etiology. **NEET-PG High-Yield Pearls:** * **Earliest sign of IDA:** Decreased **Serum Ferritin** (most sensitive biochemical marker). * **Earliest hematological change:** Increase in **RDW** (Red Cell Distribution Width), reflecting anisocytosis [1]. * **Mentzer Index (MCV/RBC count):** Used to differentiate IDA (>13) from Thalassemia trait (<13). * **Gold Standard for Iron Stores:** Bone marrow aspiration with **Perl’s Prussian Blue stain** (showing absent hemosiderin). **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 1

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 2

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 3

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 4

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 5

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 6

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

Question 7

All of the following are present in cryoprecipitate, except?

Accepted Answer

Factor V

Answer

Von Willebrand Factor

Answer

Factor I

Answer

Factor VIII

Question 8

Examination of a lymph node from the neck of a 26-year-old man with bilateral cervical lymphadenopathy reveals total effacement of nodal architecture, and at higher power, the characteristic cell shown below. Which of the following additional studies is best suited for confirmation of diagnosis in this case?

Accepted Answer

Immunohistochemistry

Answer

Serum protein electrophoresis

Answer

Flow cytometry

Answer

Gene rearrangement studies

Question 9

Smudge cells are characteristic findings in which of the following hematological malignancies?

Accepted Answer

Chronic lymphocytic leukemia

Answer

Nodular sclerosis Hodgkin's lymphoma

Answer

Lymphocyte predominant Hodgkin's lymphoma

Answer

Sezary syndrome

Question 10

Which blood index most accurately reflects iron deficiency?

Accepted Answer

MCHC

Answer

MCV

Answer

MCH

Answer

PCV

Hematopathology — MCQs

Hematopathology — MCQs

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