Hematopathology Practice Questions

Q: In a patient with acute leukemia, the immunophenotype pattern shows CD 19+ve, CD 10+ve, CD33+ve, and CD13+ve. What is the most likely diagnosis?

Biphenotypic leukemia. **Explanation:** The correct answer is **Biphenotypic Leukemia**, now classified under **Mixed Phenotype Acute Leukemia (MPAL)** according to the WHO classification [1]. **1. Why it is correct:** Biphenotypic leukemia is characterized by the expression of markers from two different lineages on a single population of blasts. In this case: * **CD19 and CD10** are definitive markers for **B-lymphoid** lineage. * **CD33 and CD13** are definitive markers for **Myeloid** lineage. The simultaneous presence of both B-cell and myeloid markers satisfies the criteria for MPAL, as the blasts do not belong to a single restricted lineage. **2. Why the other options are incorrect:** * **B. Acute Lymphoblastic Leukemia (ALL):** While CD19 and CD10 are classic for B-ALL, the strong expression of myeloid markers (CD13, CD33) excludes a diagnosis of pure ALL [1]. * **C & D. AML (M2 and M0):** Although CD13 and CD33 are hallmarks of AML, the presence of B-cell specific markers like CD19 and CD10 is not typical for pure myeloid leukemia [1]. While "lineage infidelity" (weak expression of lymphoid markers) can occur in AML, the combination provided here strongly points toward a mixed phenotype. **High-Yield Clinical Pearls for NEET-PG:** * **MPAL Criteria:** Diagnosis relies on the **EGIL scoring system** or the **WHO criteria**, which require specific "strong" markers (e.g., MPO for myeloid; CD19/CD22/CD79a for B-lymphoid; cytoplasmic CD3 for T-lymphoid). * **Cytogenetics:** MPAL is frequently associated with **t(9;22)** (Philadelphia chromosome) or **MLL gene rearrangements** (11q23) [1]. * **Prognosis:** Generally carries a **poorer prognosis** compared to standard AML or ALL and often requires intensive "hybrid" chemotherapy protocols. **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. 596-600.

Q: Appearance of characteristic “burr cells”, “helmet cells” and “triangle cells” in peripheral blood smears is indicative of:

Schistocytosis. The presence of fragmented red blood cells, such as **burr cells (echinocytes)**, **helmet cells**, and **triangle cells**, is the hallmark of **Schistocytosis**. 1. **Why Schistocytosis is correct:** Schistocytes are fragmented parts of red blood cells formed when the RBC membrane is mechanically severed. This typically occurs in **Microangiopathic Hemolytic Anemia (MAHA)**, such as TTP, HUS, or DIC, where fibrin strands in small vessels "slice" the RBCs as they pass through. They are also seen in mechanical heart valve-induced hemolysis. 2. **Why other options are incorrect:** * **Polychromasia:** Refers to the presence of young, bluish-grey RBCs (reticulocytes) on a peripheral smear, indicating active erythropoiesis in the bone marrow. * **Anisocytosis:** Refers to a variation in the **size** of RBCs (measured by RDW). It is a non-specific finding seen in most anemias (e.g., Iron Deficiency Anemia). * **Poikilocytosis:** This is a general umbrella term for any variation in the **shape** of RBCs. While schistocytes are a type of poikilocyte, "Schistocytosis" is the specific and most accurate clinical term for the fragments described in the question. **NEET-PG High-Yield Pearls:** * **Burr cells (Echinocytes):** Characterized by small, uniform blunt projections. Commonly seen in **Uremia** and chronic kidney disease. * **Acanthocytes (Spur cells):** Irregular, sharp projections. Seen in **Abetalipoproteinemia** and Liver disease. * **Bite cells (Degmacytes):** Result from splenic macrophages pitting out Heinz bodies. Diagnostic of **G6PD Deficiency** [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 642-643.

Q: In microangiopathic hemolytic anemia, what type of red blood cells are typically seen?

Schistocytes. **Explanation:** **Microangiopathic Hemolytic Anemia (MAHA)** is characterized by the mechanical destruction of red blood cells (intravascular hemolysis) as they pass through small vessels partially occluded by microthrombi (fibrin or platelet plugs) [1]. **Why Schistocytes are correct:** As RBCs attempt to squeeze through these narrowed, fibrin-rich vascular channels, they are physically "sliced" or sheared by the fibrin strands. This mechanical trauma results in fragmented, irregularly shaped RBC remnants [1] known as **Schistocytes** (also called helmet cells or triangle cells). Their presence on a peripheral blood smear is the hallmark of MAHA. **Analysis of Incorrect Options:** * **Fragmented RBCs (Option A):** While schistocytes are technically fragmented RBCs, "Schistocyte" is the specific morphological term used in hematopathology. In NEET-PG, always choose the most specific medical term provided. * **Spherocytes (Option C):** These are small, round RBCs lacking central pallor, typically seen in **Hereditary Spherocytosis** or **Autoimmune Hemolytic Anemia (AIHA)**, where splenic macrophages "bite" off portions of the cell membrane. * **Anisocytes (Option D):** This term refers to a variation in RBC **size** (measured by RDW). While seen in many anemias (like Iron Deficiency), it is not the diagnostic feature of MAHA. **Clinical Pearls for NEET-PG:** * **Classic Triad of MAHA:** Anemia, Schistocytes on smear, and elevated LDH/low haptoglobin. * **Key Conditions:** MAHA is seen in **TTP** (ADAMTS13 deficiency), **HUS** (Shiga toxin), **DIC**, and Malignant Hypertension [1]. * **Coombs Test:** MAHA is characteristically **Coombs Negative** (distinguishing it from AIHA). **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 540-541.

Q: Which of the following characterizes Chronic Lymphocytic Leukemia (CLL)?

All of the above. **Explanation:** Chronic Lymphocytic Leukemia (CLL) is a monoclonal proliferation of mature-appearing B-lymphocytes and is the most common leukemia in the Western world [1]. * **Option A:** The hallmark of CLL is the accumulation of **small, mature-looking lymphocytes** with clumped "soccer-ball" chromatin. Due to their fragility, these cells often rupture during smear preparation, forming characteristic **Smudge cells** (Basket cells) [1]. * **Option B:** CLL is predominantly a disease of the **elderly**, with a median age at diagnosis of around 70 years [2]. It is rarely seen in individuals under 40, making "over 50 years" a highly characteristic demographic [2]. * **Option C:** As a systemic lymphoproliferative disorder, malignant cells infiltrate the reticuloendothelial system. This leads to painless generalized lymphadenopathy and **hepatosplenomegaly** in a significant number of patients. Since all three clinical and morphological features are classic presentations of the disease, **Option D** is the correct answer. **High-Yield NEET-PG Pearls:** * **Immunophenotype:** CLL cells characteristically express **CD5** (a T-cell marker), **CD19, CD20, and CD23** [1]. * **Richter Transformation:** In 5-10% of cases, CLL can transform into a high-grade **Diffuse Large B-cell Lymphoma (DLBCL)**, signaled by sudden clinical worsening. * **Diagnosis:** A persistent absolute lymphocyte count of **>5,000/µL** is required for diagnosis. * **Prognosis:** ZAP-70 expression and unmutated IgVH genes indicate a poorer prognosis. **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. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613.

Question 1

Patients with Classic Von Willebrand's disease have what laboratory findings?

Accepted Answer

Prolonged bleeding time, prolonged activated partial thromboplastin time (APTT)

Answer

Decreased bleeding time, prolonged activated partial thromboplastin time (APTT)

Answer

Prolonged bleeding time, decreased activated partial thromboplastin time (APTT)

Answer

Decreased bleeding time, decreased activated partial thromboplastin time (APTT)

Question 2

In a patient with acute leukemia, the immunophenotype pattern shows CD 19+ve, CD 10+ve, CD33+ve, and CD13+ve. What is the most likely diagnosis?

Accepted Answer

Biphenotypic leukemia

Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

Acute Myeloid Leukemia - M2 (AML-M2)

Answer

Acute Myeloid Leukemia - M0 (AML-M0)

Question 3

Appearance of characteristic “burr cells”, “helmet cells” and “triangle cells” in peripheral blood smears is indicative of:

Accepted Answer

Schistocytosis

Answer

Polychromasia

Answer

Anisocytosis

Answer

Poikilocytosis

Question 4

Which of the following is a Vitamin K dependent clotting factor?

Accepted Answer

Factor VII

Answer

Factor I

Answer

Factor XI

Answer

Factor XII

Question 5

In microangiopathic hemolytic anemia, what type of red blood cells are typically seen?

Accepted Answer

Schistocytes

Answer

Fragmented RBCs

Answer

Spherocytes

Answer

Anisocytes

Question 6

What bone marrow finding is characteristic of myelofibrosis?

Accepted Answer

All of the above

Answer

Leucoerythroblastosis

Answer

Tear drop cells

Answer

Leucocytopenia

Question 7

A patient with cirrhosis of the liver has the following coagulation parameters: Platelet count 2,00,000/µL, Prothrombin time 25s (control 12s), Activated partial thromboplastin time 60s (control 35s), Thrombin time 15s (control 15s). What is expected in this patient?

Accepted Answer

D-dimer will be normal

Answer

Fibrinogen will be <100 mg/dL

Answer

Antithrombin III will be high

Answer

Protein C will be elevated

Question 8

Direct Coombs test positive is seen in all of the following conditions EXCEPT?

Accepted Answer

Aplastic anemia

Answer

ABO incompatibility

Answer

Hemolytic disease of the newborn

Answer

Autoimmune hemolysis

Question 9

A 7-month-old child presents with failure to thrive and a hemoglobin level of 4.4 g/dL. Peripheral smear examination reveals very small red blood cells with marked pallor. Laboratory tests show very low levels of hemoglobin A, with elevated fractions of hemoglobin A2 and hemoglobin F. Which of the following underlying mechanisms is most likely responsible for these findings?

Accepted Answer

Insufficient production of beta-globin

Answer

Amino acid substitution on the beta-globin chain

Answer

Antibody against fetal red blood cells

Answer

Defect in cytoskeletal proteins

Question 10

Which of the following characterizes Chronic Lymphocytic Leukemia (CLL)?

Accepted Answer

All of the above

Answer

Presence of small lymphocytes in peripheral smear

Answer

Commonly seen in individuals over 50 years of age

Answer

Hepatosplenomegaly

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?