Hematopathology Practice Questions

Q: Which of the following is most likely to cause a hypochromic microcytic anemia?

Iron deficiency anemia. **Explanation:** **Iron Deficiency Anemia (IDA)** is the most common cause of **microcytic hypochromic anemia** worldwide [1], [4]. The underlying mechanism involves a decrease in hemoglobin synthesis. Hemoglobin is composed of heme (iron + protoporphyrin) and globin. When iron is deficient, heme production drops, leading to fewer hemoglobin molecules per cell. Consequently, erythrocytes undergo extra divisions to maintain concentration, resulting in smaller cells (**Microcytic: MCV 100 fL) [2]. Folate is essential for DNA synthesis; its deficiency leads to impaired nuclear maturation while cytoplasmic growth continues, resulting in large, oval red cells and hypersegmented neutrophils. * **Hereditary spherocytosis:** This is a normocytic or mildly microcytic hemolytic anemia. Crucially, it is **hyperchromic** (elevated MCHC) because the loss of membrane surface area causes the cell to become spherical and densely packed with hemoglobin. * **Sickle cell anemia:** This is typically a **Normocytic normochromic** anemia. While it is a qualitative hemoglobinopathy (HbS), the size and color of the cells are generally normal unless there is a co-existing iron deficiency or alpha-thalassemia. **High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis for Microcytic Anemia (TAIL):** **T**halassemia, **A**nemia of Chronic Disease (late stage), **I**ron Deficiency, **L**ead poisoning/Sideroblastic anemia [1]. * **Best Screening Test for IDA:** Serum Ferritin (decreased). * **Earliest Sign of Response to Iron Therapy:** Reticulocytosis (usually within 5–7 days). * **Mentzer Index:** MCV/RBC count. If ** 13**, suspect Iron Deficiency Anemia.

Q: Which of the following are features of iron deficiency anemia?

Decreased TIBC. **Explanation:** Iron Deficiency Anemia (IDA) is a microcytic hypochromic anemia characterized by a depletion of body iron stores [1]. The question asks to identify a feature that is **NOT** typically seen in IDA (or specifically, which of the listed options is incorrect regarding the pathophysiology of IDA). **Understanding the Correct Answer (C):** In IDA, **Total Iron Binding Capacity (TIBC)** is **increased**, not decreased [1]. TIBC is a functional measurement of Transferrin. When iron stores are low, the liver compensates by increasing the synthesis of Transferrin to maximize the transport of any available iron. Therefore, an elevated TIBC is a hallmark diagnostic feature of IDA [1]. **Analysis of Incorrect Options:** * **A. Increased RDW:** Red Cell Distribution Width (RDW) measures the variation in RBC size (anisocytosis). IDA is one of the first anemias to show an increased RDW as the body begins producing smaller cells alongside normal ones. * **B. Decreased Serum Iron:** This is a direct consequence of depleted iron levels and a primary finding in IDA [1]. * **D. Decreased Serum Ferritin:** Ferritin reflects total body iron stores. A low serum ferritin is the **most specific** initial laboratory finding for IDA [1]. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Bone marrow aspiration (Prussian blue staining) showing absent haemosiderin in macrophages. * **Earliest Sign:** Decreased serum ferritin [1]. * **Differential Diagnosis:** In **Anemia of Chronic Disease (ACD)**, TIBC is decreased and Ferritin is increased (as it acts as an acute-phase reactant), which helps distinguish it from IDA. * **Mentzer Index:** (MCV/RBC count) > 13 suggests IDA, while < 13 suggests Thalassemia trait.

Q: Which of the following hematological malignancies is responsible for the finding shown in the image?

Acute myeloid leukemia (AML). ***Acute myeloid leukemia (AML)*** - The image shows **Auer rods**, which are **pathognomonic** (diagnostic) for AML and represent abnormal **azurophilic granules** in myeloid blast cells. - These pink-red, needle-like cytoplasmic inclusions are **highly specific** for AML and help distinguish it from other leukemias on **peripheral blood smear**. *Myelodysplastic syndrome (MDS)* - MDS shows **dysplastic changes** in blood cells but typically lacks **blast cells with Auer rods**. - Characterized by **cytopenia** with **hypercellular bone marrow** and morphological abnormalities, not the acute blast proliferation seen here. *Childhood chronic myeloid leukemia (CML)* - CML presents with **mature granulocytes** at various stages of development, not primitive blast cells. - The **Philadelphia chromosome** (BCR-ABL) is characteristic, and **Auer rods are not found** in CML cells. *Acute lymphoblastic leukemia (ALL)* - ALL involves **lymphoid blasts** that are typically **smaller and more uniform** than myeloid blasts. - **Auer rods are absent** in ALL as they are specific to **myeloid lineage** malignancies, not lymphoid.

Q: A 9-year-old child presents with continuous bleeding after tonsillectomy. Bleeding time and PTT are prolonged, while platelet count and PT are normal. What is the most likely diagnosis?

Von Willebrand disease. ### Explanation The clinical presentation of post-surgical bleeding combined with a specific laboratory profile points toward **Von Willebrand Disease (vWD)**, the most common inherited bleeding disorder. **Why Von Willebrand Disease is Correct:** Von Willebrand Factor (vWF) has two primary roles: 1. **Platelet Adhesion:** It acts as a bridge between platelets and the subendothelium. A deficiency leads to a defect in the platelet plug formation, resulting in a **prolonged Bleeding Time (BT)**. 2. **Carrier for Factor VIII:** vWF stabilizes Factor VIII in circulation. Low levels of vWF lead to a secondary decrease in Factor VIII, which causes a **prolonged Partial Thromboplastin Time (PTT)**. Since vWD does not affect the extrinsic pathway or platelet production, the **PT and Platelet count remain normal**. **Why Other Options are Incorrect:** * **Vitamin K Deficiency:** Affects Factors II, VII, IX, and X. This would primarily prolong the **PT** (due to Factor VII's short half-life) and PTT, but BT would be normal. * **Immune Thrombocytopenic Purpura (ITP):** Characterized by isolated **thrombocytopenia** (low platelet count). While BT would be prolonged, the PTT would be normal. * **Hemophilia A:** An isolated deficiency of Factor VIII. It causes a prolonged PTT, but the **BT is normal** because platelet-vWF interaction is unaffected. **High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Most common type (Type 1) is Autosomal Dominant. * **Screening Tests:** Prolonged BT + Prolonged PTT + Normal Platelet Count. * **Confirmatory Test:** Ristocetin Cofactor Assay (measures vWF activity). * **Treatment of Choice:** Desmopressin (DDAVP), which releases stored vWF from Weibel-Palade bodies. For severe cases, use vWF-containing concentrates.

Q: These types of RBCs are seen in which condition?

Chronic renal failure (CRF). ***Chronic renal failure (CRF)*** - **Echinocytes** (burr cells) are the characteristic RBC morphology seen in **chronic renal failure** due to uremic toxins affecting the RBC membrane. - **Uremia** causes metabolic changes that alter RBC shape, creating the spiky appearance of echinocytes on peripheral blood smear. *Hereditary spherocytosis* - Characterized by **spherocytes** (round, dense RBCs without central pallor) due to **membrane protein defects**. - Results from deficiencies in **spectrin**, **ankyrin**, or other membrane proteins, not the spiky echinocytes seen in the question. *Myelofibrosis* -典型表现为 **teardrop cells** (dacrocytes) due to **bone marrow fibrosis** causing mechanical distortion of RBCs. - Associated with **leukoerythroblastic** blood picture and **extramedullary hematopoiesis**, not echinocytes. *Myelodysplastic syndrome* - Features **dysplastic RBCs** with various morphological abnormalities including **macro-ovalocytes** and **dimorphic populations**. - Characterized by **ineffective erythropoiesis** and clonal stem cell disorders, not the uniform echinocyte morphology.

Q: A 60-year-old male patient complains of bleeding gums and loss of appetite. Histopathologic examination reveals basophilic leukocytosis. What condition might this patient have?

Chronic myeloid leukemia. The presence of **basophilic leukocytosis** (basophilia) is a hallmark diagnostic clue for **Chronic Myeloid Leukemia (CML)**. In clinical practice and for the NEET-PG exam, an absolute basophil count >2% is highly suggestive of a myeloproliferative neoplasm, and CML is the most common cause. **Why CML is correct:** CML is a myeloproliferative disorder characterized by the uncontrolled proliferation of the myeloid lineage. It typically presents with a massive shift to the left in the white cell line. Basophilia is a classic feature of CML and is often used as a marker for disease progression; an increasing basophil count often signals a transition from the Chronic Phase to the Accelerated Phase or Blast Crisis [1]. **Why other options are incorrect:** * **Hodgkin Lymphoma:** While it can cause eosinophilia, basophilia is not a characteristic feature. It typically presents with painless lymphadenopathy and Reed-Sternberg cells. * **Systemic Lupus Erythematosus (SLE):** SLE is an autoimmune condition usually associated with cytopenias (leukopenia, anemia, thrombocytopenia) rather than leukocytosis or basophilia. * **Bordetella pertussis:** This infection is famous for causing a marked **lymphocytosis** (absolute increase in lymphocytes), not basophilia. **High-Yield Clinical Pearls for NEET-PG:** * **Philadelphia Chromosome:** t(9;22) resulting in the *BCR-ABL1* fusion gene is the cytogenetic hallmark of CML [1]. * **LAP Score:** Leukocyte Alkaline Phosphatase (LAP) score is **decreased** in CML (helps differentiate it from a Leukemoid reaction where the score is increased). * **Drug of Choice:** Imatinib (Tyrosine Kinase Inhibitor) [1]. * **Splenomegaly:** CML is a common cause of massive splenomegaly [2].

Question 1

What is true about Burkitt's lymphoma?

Accepted Answer

CD34 negative and surface immunoglobulin positive

Answer

CD34 positive and surface immunoglobulin positive

Answer

CD34 positive and surface immunoglobulin negative

Answer

CD34 negative and surface immunoglobulin negative

Question 2

Which of the following is most likely to cause a hypochromic microcytic anemia?

Accepted Answer

Iron deficiency anemia

Answer

Folate deficiency

Answer

Hereditary spherocytosis

Answer

Sickle cell anemia

Question 3

A 65-year-old man presents with anemia and back pain. A panoramic radiograph reveals multiple radiolucencies. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma

Answer

Osteosarcoma

Answer

Giant cell granuloma

Answer

Eosinophilic granuloma

Question 4

Which of the following are features of iron deficiency anemia?

Accepted Answer

Decreased TIBC

Answer

Increased RDW

Answer

Decreased serum iron

Answer

Decreased serum ferritin

Question 5

Which clotting factor deficiency is asymptomatic?

Accepted Answer

XII

Answer

II

Answer

V

Answer

XI

Question 6

Which of the following hematological malignancies is responsible for the finding shown in the image?

Accepted Answer

Acute myeloid leukemia (AML)

Answer

Myelodysplastic syndrome (MDS)

Answer

Childhood chronic myeloid leukemia (CML)

Answer

Acute lymphoblastic leukemia (ALL)

Question 7

A 9-year-old child presents with continuous bleeding after tonsillectomy. Bleeding time and PTT are prolonged, while platelet count and PT are normal. What is the most likely diagnosis?

Accepted Answer

Von Willebrand disease

Answer

Vitamin K deficiency

Answer

Immune thrombocytopenic purpura

Answer

Hemophilia A

Question 8

A patient of multiple myeloma presents with bony lesions. What is the best prognostic marker for the disease?

Accepted Answer

Beta-2 microglobulin

Answer

Bone marrow plasma cell percentage

Answer

Serum calcium level

Answer

Beta-1 microglobulin

Question 9

These types of RBCs are seen in which condition?

Accepted Answer

Chronic renal failure (CRF)

Answer

Hereditary spherocytosis

Answer

Myelofibrosis

Answer

Myelodysplastic syndrome

Question 10

A 60-year-old male patient complains of bleeding gums and loss of appetite. Histopathologic examination reveals basophilic leukocytosis. What condition might this patient have?

Accepted Answer

Chronic myeloid leukemia

Answer

Hodgkin lymphoma

Answer

Systemic lupus erythematosus

Answer

Bordetella pertussis infection

Hematopathology — MCQs

Hematopathology — MCQs

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