Hematopathology Practice Questions

Q: Which of the following is NOT a B cell marker?

CD 135. The identification of lymphocytes via **Cluster of Differentiation (CD)** markers is a high-yield topic in histology and pathology. B cells express specific surface antigens at various stages of their development [1], which are used clinically for immunophenotyping. **Why CD 135 is the correct answer:** **CD 135** (also known as Flt3) is a cytokine receptor expressed on **multipotent hematopoietic stem cells** and common lymphoid/myeloid progenitors. While it plays a role in the early commitment of cells to the lymphoid lineage, it is not a specific marker for B cells. It is primarily associated with early hematopoiesis and is often overexpressed in **Acute Myeloid Leukemia (AML)**. **Analysis of incorrect options (B cell markers):** * **CD 19:** This is the most specific and reliable pan-B cell marker. It is expressed from the earliest pro-B cell stage until just before terminal differentiation into plasma cells. * **CD 20:** A classic pan-B cell marker expressed on mature B cells. It is the clinical target for the monoclonal antibody **Rituximab**. Like CD 19, it is lost during the transition to plasma cells. * **CD 10:** Also known as **CALLA** (Common Acute Lymphoblastic Leukemia Antigen). It is expressed on pre-B cells and germinal center B cells. It is a crucial marker for diagnosing Childhood Acute Lymphoblastic Leukemia (ALL). **High-Yield Clinical Pearls for NEET-PG:** * **Pan-B cell markers:** CD 19, CD 20, CD 21, CD 22, and CD 79a. * **Plasma Cell markers:** CD 138 (Syndecan-1) and CD 38. (Note: Plasma cells usually lose CD 19 and CD 20). * **T-cell markers:** CD 3 (universal), CD 4 (Helper), CD 8 (Cytotoxic). * **NK cell markers:** CD 16 and CD 56.

Q: A 4-year-old female is being evaluated for the sudden onset of multiple petechiae and bruises. She is found to have a peripheral leukocyte count of 55,000, 86% of which are small, homogeneous cells that have nuclei with immature chromatin. Indistinct nucleoli are also present. Initial tests on these immature cells are as follows: TdT, positive; PAS, positive; acid phosphatase, positive; and myeloperoxidase, negative. Based on these findings, the immature cells most likely originated from?

Lymphoblasts. **Explanation:** The clinical presentation of a 4-year-old with petechiae, bruising, and a high leukocyte count (55,000/µL) with immature cells strongly suggests **Acute Lymphoblastic Leukemia (ALL)**, the most common pediatric malignancy. **Why Lymphoblasts are correct:** The diagnosis is confirmed by the specific cytochemical and immunophenotypic profile: * **TdT (Terminal Deoxynucleotidyl Transferase):** A hallmark marker for immature lymphocytes (both B and T cells). It is absent in myeloid cells. * **PAS (Periodic Acid-Schiff):** Characteristically shows "block-like" positivity in lymphoblasts. * **Acid Phosphatase:** Strong focal positivity in the perinuclear area is highly suggestive of **T-cell ALL**. * **MPO (Myeloperoxidase):** Negative results rule out myeloid lineage. * **Morphology:** Small, homogeneous cells with immature chromatin and indistinct nucleoli are characteristic of the **L1 subtype** (FAB classification), common in childhood ALL. **Why other options are incorrect:** * **Myeloblasts:** Would be **MPO positive** and TdT negative. They typically show Auer rods and more prominent nucleoli. * **Monoblasts:** Characteristically show **Non-specific Esterase (NSE)** positivity and are MPO negative or weakly positive. * **Megakaryoblasts:** Associated with AML-M7; they are usually negative for PAS and TdT but positive for platelet markers like CD41/CD61. **High-Yield Pearls for NEET-PG:** 1. **Most common childhood cancer:** ALL (Peak age: 2–5 years). 2. **Best Prognostic Factor:** Age 1–10 years and WBC count <50,000. 3. **Cytogenetics:** t(12;21) has a good prognosis; t(9;22) or Philadelphia chromosome has a poor prognosis. 4. **Common sites of relapse:** Testes and CNS (due to the blood-brain/blood-testis barrier).

Q: The peripheral blood smear of an anemic 1-year-old child is shown in the illustration. The most likely diagnosis is?

Iron deficiency anemia.. ***Iron deficiency anemia*** - The peripheral blood smear shows **microcytic hypochromic RBCs** with **increased central pallor** and **pencil cells** (cigar-shaped cells), which are characteristic findings in iron deficiency anemia. - This is the most common cause of anemia in **1-year-old children** due to rapid growth, inadequate dietary iron intake, and transition from breast milk to solid foods. *Anemia of chronic disease* - Typically presents with **normocytic normochromic** RBCs or mildly microcytic cells, not the severe microcytosis and hypochromia seen here. - Usually associated with underlying **chronic inflammatory conditions** like infections or autoimmune diseases, which are less common in healthy 1-year-olds. *Aplastic anemia* - Characterized by **pancytopenia** (decreased RBCs, WBCs, and platelets) with **normocytic normochromic** RBCs on peripheral smear. - The peripheral smear would show **reduced cell counts** across all lineages, not the microcytic hypochromic picture described. *Hereditary spherocytosis* - Shows **spherocytes** (round RBCs lacking central pallor) and **polychromasia** due to increased reticulocyte production from hemolysis. - Associated with **splenomegaly** and **unconjugated hyperbilirubinemia**, presenting with jaundice rather than the microcytic pattern seen here.

Question 1

Features seen in hemolytic anemia are all, EXCEPT:

Accepted Answer

Tear drop and Burr cells

Answer

Reduced Haptoglobin

Answer

Reticulocytosis

Answer

Hemoglobinuria

Question 2

A patient presents with progressive pallor, hyper-segmented neutrophils, and an MCV > 100 fL. What is the most likely diagnosis?

Accepted Answer

Megaloblastic anemia

Answer

Hereditary spherocytosis

Answer

Dimorphic anemia

Answer

Thalassemia

Question 3

Which of the following is NOT a B cell marker?

Accepted Answer

CD 135

Answer

CD 19

Answer

CD 20

Answer

CD 10

Question 4

A 4-year-old female is being evaluated for the sudden onset of multiple petechiae and bruises. She is found to have a peripheral leukocyte count of 55,000, 86% of which are small, homogeneous cells that have nuclei with immature chromatin. Indistinct nucleoli are also present. Initial tests on these immature cells are as follows: TdT, positive; PAS, positive; acid phosphatase, positive; and myeloperoxidase, negative. Based on these findings, the immature cells most likely originated from?

Accepted Answer

Lymphoblasts

Answer

Monoblasts

Answer

Megakaryoblasts

Answer

Myeloblasts

Question 5

Which of the following statements regarding umbilical cord banking is FALSE?

Accepted Answer

Blood is collected from the umbilical artery.

Answer

It is used for allogeneic stem cell transplant.

Answer

Transplantation can be done in people with different HLA matching.

Answer

Blood is preserved by cryopreservation.

Question 6

Russel bodies are seen in which of the following conditions?

Accepted Answer

Multiple Myeloma

Answer

Rabies

Answer

Parkinsonism

Answer

Intracranial neoplasm

Question 7

The type of non-Hodgkin's lymphoma with the highest rate of gastrointestinal system involvement is:

Accepted Answer

Extranodal marginal zone B cell lymphoma of MALT type

Answer

B cell chronic lymphocytic leukemia

Answer

Mantle cell lymphoma

Answer

Follicular lymphoma

Question 8

The Coombs test is used for diagnosing which of the following conditions?

Accepted Answer

Antibody-mediated hemolytic anemia

Answer

Thalassemia

Answer

Sickle cell anemia

Answer

G6PD deficiency

Question 9

Factor IX deficiency results in increased which of the following?

Accepted Answer

Partial Thromboplastin Time (PTT)

Answer

Prothrombin Time (PT)

Answer

Bleeding Time (BT)

Answer

Thrombin Time (TT)

Question 10

The peripheral blood smear of an anemic 1-year-old child is shown in the illustration. The most likely diagnosis is?

Accepted Answer

Iron deficiency anemia.

Answer

Anemia of chronic disease.

Answer

Aplastic anemia.

Answer

Hereditary spherocytosis.

Hematopathology — MCQs

Hematopathology — MCQs

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