Hematopathology Practice Questions

Q: Acanthocytes are seen in which of the following conditions?

Abetalipoproteinemia. **Explanation:** **Acanthocytes** (also known as spur cells) are red blood cells with irregularly spaced, thorny, or spiked cytoplasmic projections of varying lengths [2]. **1. Why Abetalipoproteinemia is correct:** Abetalipoproteinemia is an autosomal recessive disorder caused by a mutation in the **MTTP gene**, leading to a deficiency in Apolipoprotein B-48 and B-100. This results in an inability to synthesize chylomicrons and VLDLs. The lack of these lipoproteins leads to an abnormal lipid composition in the RBC membrane (specifically an accumulation of sphingomyelin), which decreases membrane fluidity and causes the characteristic "spiked" acanthocyte morphology. **2. Why other options are incorrect:** * **Hampy’s disease:** This is not a standard medical term associated with hematological or histological pathology. It may be a distractor for Hartnup disease (a disorder of amino acid transport) or simply a "filler" option. * **Whipple disease:** Caused by the bacterium *Tropheryma whipplei*, this is a systemic infectious disease primarily affecting the small intestine. Histologically, it is characterized by **PAS-positive macrophages** in the lamina propria, not acanthocytes. **3. High-Yield Clinical Pearls for NEET-PG:** * **Acanthocytes** are also seen in: Severe liver disease (Spur cell anemia), McLeod syndrome, and Post-splenectomy states [2]. * **Abetalipoproteinemia Triad:** Acanthocytosis, Steatorrhea (malabsorption of fat-soluble vitamins A, D, E, K), and Retinitis pigmentosa/Ataxia [1]. * **Differentiate from Echinocytes (Burr cells):** These have *regularly* spaced, shorter projections and are seen in Uremia, Pyruvate kinase deficiency, and Gastric cancer.

Q: Cryoprecipitate is rich in which of the following factors?

Factor VIII. **Explanation:** Cryoprecipitate is the cold-insoluble fraction of plasma obtained by thawing fresh frozen plasma (FFP) at 1–6°C. It is a concentrated source of specific coagulation proteins. **Why Factor VIII is correct:** Cryoprecipitate is specifically enriched with five key components: **Factor VIII** (anti-hemophilic factor), **Von Willebrand Factor (vWF)**, **Fibrinogen** (Factor I), **Factor XIII**, and **Fibronectin**. It contains approximately 80–120 units of Factor VIII per bag, making it a traditional treatment for Hemophilia A and Von Willebrand disease (though recombinant factors are now preferred). **Why other options are incorrect:** * **Factor II (Prothrombin), Factor VII, and Factor IX:** These are Vitamin K-dependent factors. They remain in the supernatant (cryo-poor plasma) during the thawing process and are not concentrated in the cryoprecipitate. These factors are best replaced using **Prothrombin Complex Concentrate (PCC)** or **FFP**. * **Factor V:** This is a labile factor found in FFP but is not significantly concentrated in cryoprecipitate. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Indication:** Currently, the most common clinical use of cryoprecipitate is **hypofibrinogenemia** (e.g., in DIC or massive hemorrhage) because it provides a high concentration of Fibrinogen in a small volume. * **Storage:** It is stored at **-18°C or colder** and has a shelf life of 1 year. Once thawed, it must be transfused within 6 hours (or 4 hours if pooled). * **Dosage:** One unit of cryoprecipitate typically raises the fibrinogen level by 5–10 mg/dL in an average adult. * **Mnemonic:** Remember **"8-1-13-vWF"** (Factors 8, 1, 13, and vWF).

Q: Eosinopenia occurs in which of the following conditions?

Cushing's disease. Cushing’s Disease is the correct answer because it is characterized by an excess of endogenous cortisol [1]. Glucocorticoids cause eosinopenia (a decrease in the number of circulating eosinophils) by promoting their sequestration in the spleen and lungs and inducing apoptosis of eosinophils. This is part of the classic "steroid-induced leukogram," which typically shows neutrophilia alongside lymphopenia, monocytopenia, and eosinopenia. Analysis of Incorrect Options: * Asthma: This is a Type I hypersensitivity reaction. Eosinophils are recruited to the airway mucosa, and peripheral eosinophilia is a common finding, reflecting the Th2-driven inflammatory response. * Hookworm Infestation: Helminthic infections are classic causes of eosinophilia. Eosinophils play a crucial role in the immune response against parasites by releasing major basic protein (MBP) and eosinophil cationic protein (ECP). * Chronic Myeloid Leukemia (CML): CML is a myeloproliferative neoplasm. It typically presents with a "leukemoid" picture involving an increase in all granulocytic cell lines, including neutrophils, basophils, and eosinophils. Basophilia and eosinophilia are important diagnostic clues for CML. High-Yield Clinical Pearls for NEET-PG: * Mnemonic for Eosinophilia (NAACP): Neoplasia, Allergy/Asthma, Addison’s disease, Connective tissue disorders, Parasites. * Addison’s vs. Cushing’s: While Cushing’s (high cortisol) causes eosinopenia, Addison’s disease (low cortisol) causes eosinophilia [1]. * Steroid Effect: Glucocorticoids "kick" neutrophils out of the marginated pool into the blood (neutrophilia) but "hide" eosinophils and lymphocytes (eosinopenia/lymphopenia).

Q: All of the following are true about beta-thalassemia trait, EXCEPT:

Patient requires blood transfusion. **Explanation:** The correct answer is **D (Patient requires blood transfusion)** because Beta-thalassemia trait (also known as Beta-thalassemia minor) is typically a **clinically asymptomatic** carrier state [1]. In this condition, there is a mutation in only one of the two beta-globin genes ($\beta/\beta^+$ or $\beta/\beta^0$). The remaining functional gene produces enough hemoglobin to maintain near-normal levels, making these patients transfusion-independent. Blood transfusions are reserved for Beta-thalassemia Major (Cooley’s Anemia), where both genes are defective. **Analysis of other options:** * **Option A:** Microcytic hypochromic anemia is a hallmark of thalassemia trait [1]. Due to reduced beta-chain synthesis, the hemoglobin content per cell is low (low MCH) and the cells are smaller (low MCV). * **Option B:** An **increased HbA2 (>3.5%)** is the diagnostic gold standard for Beta-thalassemia trait [3]. It occurs as a compensatory mechanism where delta-chain synthesis increases to offset the beta-chain deficiency. * **Option C:** HbF (Fetal hemoglobin) may be slightly elevated (usually 1–5%) in some cases of Beta-thalassemia trait, though it is significantly higher in the Major form. **High-Yield NEET-PG Pearls:** 1. **Mentzer Index:** Used to differentiate Iron Deficiency Anemia (IDA) from Thalassemia. **MCV/RBC count 13** suggests IDA. 2. **Peripheral Smear:** Characterized by **Target cells** (codocytes) and basophilic stippling [2]. 3. **NEET-PG Fact:** Unlike IDA, the RBC count in Beta-thalassemia trait is often **elevated** (polycythemia) despite low hemoglobin, as the bone marrow attempts to compensate.

Question 1

Acanthocytes are seen in which of the following conditions?

Accepted Answer

Abetalipoproteinemia

Answer

Hampy's disease

Answer

Whipple disease

Answer

None of the above

Question 2

A 55-year-old man newly diagnosed with leukemia undergoes genetic studies that reveal a t(9;22) translocation (the Philadelphia chromosome). Which of the following would a complete blood count most likely show?

Accepted Answer

Increased neutrophil count

Answer

Increased lymphocyte count

Answer

Numerous lymphoblasts

Answer

Numerous myeloblasts

Question 3

Cold haemagglutinin is associated with which type of antibody?

Accepted Answer

Donath-Landsteiner antibody

Answer

Anti-IgM

Answer

Anti-IgG

Answer

Anti-IgA

Question 4

What is the normal platelet count?

Accepted Answer

Shaken baby syndrome

Answer

D1C

Answer

Microangiopathic hemolytic anaemia

Answer

Splenomegaly

Question 5

Cryoprecipitate is rich in which of the following factors?

Accepted Answer

Factor VIII

Answer

Factor II

Answer

Factor V

Answer

Factor VII

Question 6

A 20-year-old male presents with weakness, jaundice, and hematuria. He has a history of similar, self-limiting episodes and unusual substance consumption. Examination reveals mild jaundice and splenomegaly. Lab findings include increased indirect bilirubin, hemoglobinemia, hemoglobinuria, absent haptoglobin, raised LDH, hemosiderinuria, and reticulocytosis. Which peripheral blood smear finding is most likely associated with this condition?

Accepted Answer

Smear showing Pappenheimer bodies.

Answer

Smear showing target cells and bite cells.

Answer

Smear showing schistocytes and helmet cells.

Answer

Smear showing rouleaux formation.

Question 7

Eosinopenia occurs in which of the following conditions?

Accepted Answer

Cushing's disease

Answer

Asthma

Answer

Hookworm infestation

Answer

Chronic myeloid leukemia

Question 8

Necrotizing ragged ulceration with no apparent inflammatory response is indicative of which of the following conditions?

Accepted Answer

Agranulocytosis

Answer

Leukocytosis

Answer

Polycythemia vera

Answer

Sickle cell anemia

Question 9

Which of the following is NOT included in the myeloproliferative neoplasms?

Accepted Answer

Erythroleukemia

Answer

Angiogenic myeloid metaplasia

Answer

Thrombocythemia

Answer

Megaloblastic hyperplasia

Question 10

All of the following are true about beta-thalassemia trait, EXCEPT:

Accepted Answer

Patient requires blood transfusion

Answer

Microcytic hypochromic blood picture

Answer

Increased HbA2

Answer

Increased HbF

Hematopathology — MCQs

Hematopathology — MCQs

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