Hematopathology Practice Questions

Q: Acid Citrate Dextrose (ACD) is used to store blood and preserves Red Blood Cells (RBCs) for 21 days. What are the respective storage periods when phosphate alone is added to ACD, and when adenine and phosphate are added together to ACD?

21 days and 35 days. ### Explanation The storage life of Red Blood Cells (RBCs) in a blood bank depends on the composition of the anticoagulant-preservative solution, which maintains cell viability by providing nutrients and preventing metabolic decay. **1. Understanding the Correct Answer (Option B):** * **ACD (Acid Citrate Dextrose):** The baseline storage period is **21 days**. Citrate acts as an anticoagulant, while Dextrose provides a substrate for ATP production via glycolysis. * **CPD (Citrate Phosphate Dextrose):** When **Phosphate** is added to ACD, the storage period remains **21 days**. However, Phosphate acts as a buffer to maintain pH and maintains higher levels of 2,3-DPG, ensuring better oxygen delivery post-transfusion. * **CPDA-1 (Citrate Phosphate Dextrose Adenine):** When **Adenine** is added along with Phosphate, the storage period increases to **35 days**. Adenine provides a substrate for the synthesis of ATP, which is essential for maintaining the RBC membrane integrity and the sodium-potassium pump. **2. Why Other Options are Incorrect:** * **Option A & D:** 42 days is the storage life for **Additive Solutions** (like SAGM: Saline-Adenine-Glucose-Mannitol), not CPDA-1. 35 days refers to CPDA-1, not CPD alone. * **Option C:** 28 days and 45 days are not standard storage durations for the primary anticoagulant solutions used in clinical practice. **3. Clinical Pearls for NEET-PG:** * **Storage Temperature:** Blood is stored at **2°C to 6°C**. * **The "Storage Lesion":** During storage, there is a decrease in pH, 2,3-DPG, and Sodium, while there is an **increase in Potassium** and Lactate. * **SAGM (Additive Solution):** Extends shelf life to **42 days** by providing optimal nutrients after the plasma is removed. * **Frozen RBCs:** Can be stored for up to **10 years** using Glycerol as a cryoprotectant.

Q: A patient with Myeloproliferative Neoplasm presents with decreased white cell count and decreased platelets. What is the most likely diagnosis?

Myelofibrosis. **Explanation:** The correct answer is **Myelofibrosis (Primary Myelofibrosis)**. **Why it is correct:** While most Myeloproliferative Neoplasms (MPNs) initially present with an increase in cell counts, Primary Myelofibrosis (PMF) is unique due to its progression into a **"spent phase."** In PMF, neoplastic megakaryocytes release cytokines like TGF-β, which stimulate fibroblasts to deposit collagen in the bone marrow [1]. This progressive **fibrosis** replaces the hematopoietic space, leading to bone marrow failure. Consequently, patients develop **cytopenias** (decreased WBCs and platelets) and extramedullary hematopoiesis (massive splenomegaly) [1]. **Why other options are incorrect:** * **Chronic Myeloid Leukemia (CML):** Characterized by marked leukocytosis (predominantly neutrophils and myelocytes) and often thrombocytosis. Cytopenia is rare unless the patient enters a Blast Crisis. * **Polycythemia Vera (PV):** Defined by an absolute increase in red cell mass, often accompanied by leukocytosis and thrombocytosis (panmyelosis). * **Essential Thrombocytosis (ET):** Primarily presents with a significantly elevated platelet count; WBC and RBC counts are usually normal or slightly increased. **High-Yield Clinical Pearls for NEET-PG:** * **Peripheral Smear:** Look for **Dacrocytes (Tear-drop RBCs)** and a **Leukoerythroblastic picture** (immature WBCs and nucleated RBCs). * **Bone Marrow:** Characterized by a **"Dry Tap"** on aspiration due to extensive fibrosis (Silver stain/Reticulin stain is used for diagnosis). * **Genetics:** Associated with **JAK2 V617F** (approx. 50%), CALR, or MPL mutations. * **Splenomegaly:** PMF causes some of the largest spleens in clinical practice due to compensatory extramedullary hematopoiesis [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 615-616.

Question 1

What are the main components of cryoprecipitate?

Accepted Answer

Factor VIII and fibrinogen

Answer

Factor VII and fibrinogen

Answer

Factor V and Factor VII

Answer

Factor VII and Factor VIII

Question 2

Which of the following is NOT true about BCR-ABL variants?

Accepted Answer

P190 is associated with an indolent clinical course.

Answer

P190 is considered a poor prognostic factor.

Answer

P230 is found in chronic neutrophilic leukemia.

Answer

P230 is associated with an indolent clinical course.

Question 3

Di Guglielmo's disease refers to which of the following conditions?

Accepted Answer

Erythroleukemia

Answer

Megakaryoblastic leukemia

Answer

Monocytic leukemia

Answer

Myelomonocytic leukemia

Question 4

Acid Citrate Dextrose (ACD) is used to store blood and preserves Red Blood Cells (RBCs) for 21 days. What are the respective storage periods when phosphate alone is added to ACD, and when adenine and phosphate are added together to ACD?

Accepted Answer

21 days and 35 days

Answer

35 days and 42 days

Answer

28 days and 45 days

Answer

35 days and 28 days

Question 5

A patient with Myeloproliferative Neoplasm presents with decreased white cell count and decreased platelets. What is the most likely diagnosis?

Accepted Answer

Myelofibrosis

Answer

Chronic myeloid leukemia

Answer

Polycythemia vera

Answer

Essential thrombocytosis

Question 6

A 40-year-old female presented with acute painful swelling of the left leg. Ultrasound of the left leg showed deep venous thrombosis. Which of the following abnormalities is least likely to be involved in this condition?

Accepted Answer

Hypohomocysteinemia

Answer

Factor V Leiden mutation

Answer

Prothrombin gene mutation

Answer

Protein C deficiency

Question 7

Transfusing blood after prolonged storage could lead to which of the following complications?

Accepted Answer

Potassium intoxication

Answer

Citrate intoxication

Answer

Circulatory overload

Answer

Hemorrhagic diathesis

Question 8

Macrophage activation syndrome is characterized by all of the following except?

Accepted Answer

Low levels of plasma ferritin

Answer

Activation of CD8+ T cells

Answer

Presence of a cytokine storm

Answer

It is another name for hemophagocytic lymphohistiocytosis

Question 9

Richter transformation is the conversion of?

Accepted Answer

CLL into DLBCL

Answer

DLBCL into CLL

Answer

SLL into CLL

Answer

CLL into SLL

Question 10

A thrombotic event is seen in all of the following conditions except?

Accepted Answer

Immune thrombocytopenic purpura (ITP)

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Answer

Disseminated intravascular coagulation (DIC)

Answer

Heparin-induced thrombocytopenia (HIT)

Hematopathology — MCQs

Hematopathology — MCQs

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