Hematopathology Practice Questions

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: 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: ABO antigens are not seen in which of the following?

Cerebrospinal fluid (CSF). ### Explanation The presence of ABO antigens in body fluids is determined by the **Se (Secretor) gene**. Approximately 80% of the population are "secretors," meaning they possess the *FUT2* gene, which allows for the expression of soluble A, B, and H antigens in various exocrine secretions. **1. Why CSF is the Correct Answer:** ABO antigens are primarily found on the surface of red blood cells, endothelial cells, and in epithelial secretions. However, they are **not found in the Cerebrospinal Fluid (CSF)**. The blood-brain barrier and the specific nature of the choroid plexus prevent these glycoproteins from being secreted into the CSF. Additionally, ABO antigens are absent from other specific tissues like the hair and compact bone. **2. Analysis of Incorrect Options:** * **Saliva (Option B):** This is the most common fluid used to determine secretor status. High concentrations of soluble antigens are found here in secretors. * **Semen (Option C):** ABO antigens are present in the seminal fluid of secretors. This is a high-yield fact in **Forensic Medicine** for identifying suspects from stains. * **Sweat (Option D):** ABO antigens are secreted by sweat glands and can be detected in perspiration, though in lower concentrations than saliva. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Secretor Status:** Controlled by the *Se* gene (FUT2) on chromosome 19. * **Universal Presence:** ABO antigens are not just on RBCs; they are "histo-blood group antigens" found on most epithelial and endothelial cells. * **Forensic Significance:** The presence of antigens in saliva, semen, and vaginal secretions allows for blood grouping from non-blood samples (Absorption-Elution method). * **The "Non-Secretor" (20%):** These individuals lack the *Se* gene and will not have ABO antigens in their body fluids, even if they have them on their RBCs.

Q: Diagnostic criteria of pure red cell aplasia (PRCA) includes all of the following, except:

Thrombocytopenia. **Explanation:** **Pure Red Cell Aplasia (PRCA)** is a rare hematological syndrome characterized by a selective and severe deficiency in erythroid precursors in the bone marrow, while the production of leukocytes and platelets remains preserved [1]. **Why Thrombocytopenia is the Correct Answer:** The hallmark of PRCA is the **isolation** of the erythroid defect. By definition, granulopoiesis (white cells) and megakaryopoiesis (platelets) are normal. Therefore, **thrombocytopenia** (low platelet count) is not a feature of PRCA. If a patient presents with anemia along with thrombocytopenia or leukopenia, the diagnosis shifts toward Aplastic Anemia or Myelodysplastic Syndrome (MDS). **Analysis of Incorrect Options:** * **Severe Anemia:** This is the primary clinical manifestation. Patients typically present with symptomatic normocytic, normochromic anemia due to the cessation of red cell production. * **Reticulocyte count < 1%:** Since there is a maturation arrest or absence of erythroid precursors in the marrow, the output of new red cells into the blood is near zero, leading to profound reticulocytopenia (typically <0.5% or <10,000/µL). * **Normocellular Marrow:** Unlike Aplastic Anemia (where the marrow is hypocellular and fatty), the marrow in PRCA is generally normocellular. The diagnostic finding is the near-complete absence of erythroid precursors (<0.5% to 1%) amidst normal myeloid and megakaryocytic lineages. **High-Yield Clinical Pearls for NEET-PG:** * **Associations:** PRCA is strongly associated with **Thymoma** (10-15% of cases). Removal of the thymoma can lead to remission. * **Infections:** Acute self-limiting PRCA is often caused by **Parvovirus B19**, which targets the P-antigen on proerythroblasts (look for **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 595-596.

Question 1

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 2

Which type of anemia is caused by iron deficiency?

Accepted Answer

Microcytic hypochromic anemia

Answer

Megaloblastic anemia

Answer

Macrocytic hypochromic anemia

Answer

Microcytic hyperchromic anemia

Question 3

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 4

These types of RBCs are seen in which condition?

Accepted Answer

Chronic renal failure (CRF)

Answer

Hereditary spherocytosis

Answer

Myelofibrosis

Answer

Myelodysplastic syndrome

Question 5

A patient has a deficiency of Von Willebrand factor. Which of the following abnormalities are seen in this patient?

Accepted Answer

Normal PT, Normal PTT

Answer

Increased PTT, increased PT

Answer

Decreased PT, Increased PTT

Answer

Normal PT & Increased PTT

Question 6

In Promyelocytic Leukemia, which of the following is NOT a typical feature?

Accepted Answer

CD15 and CD34 markers are positive on the same cell population.

Answer

All-trans retinoic acid is a key component of treatment.

Answer

A characteristic chromosomal translocation is t(15;17).

Answer

It is commonly associated with Disseminated Intravascular Coagulation (DIC).

Question 7

Which type of cell constitutes the largest population in the bone marrow?

Accepted Answer

Metamyelocytes

Answer

Promyelocytes

Answer

Erythroid cells

Answer

Myelocytes

Question 8

ABO antigens are not seen in which of the following?

Accepted Answer

Cerebrospinal fluid (CSF)

Answer

Saliva

Answer

Semen

Answer

Sweat

Question 9

Diagnostic criteria of pure red cell aplasia (PRCA) includes all of the following, except:

Accepted Answer

Thrombocytopenia

Answer

Severe anemia

Answer

Reticulocyte count < 1%

Answer

Normocellular marrow

Question 10

Fanconi's anemia is classified as which of the following types of anemia?

Accepted Answer

Constitutional anemia

Answer

Hemolytic anemia

Answer

Iron deficiency anemia

Answer

Autoimmune anemia

Hematopathology — MCQs

Hematopathology — MCQs

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