Hematopathology Practice Questions

Q: A 10-year-old child presents with anemia. Peripheral smear findings are shown below. What is the most probable type of anemia this child is suffering from?

Megaloblastic anemia. ***Megaloblastic anemia*** - Peripheral smear shows **hypersegmented neutrophils** (>5 lobes) and **macro-ovalocytes** (large, oval-shaped RBCs), pathognomonic findings of megaloblastic anemia. - Caused by **vitamin B12** or **folate deficiency**, leading to impaired DNA synthesis and characteristic morphological changes. *Hemolytic anemia* - Peripheral smear would show **spherocytes**, **schistocytes**, **polychromasia**, and **reticulocytosis** indicating RBC destruction. - **Elevated indirect bilirubin** and **LDH** would be present, with normal or increased reticulocyte count. *Aplastic anemia* - Peripheral smear demonstrates **pancytopenia** with **normocytic, normochromic** RBCs and absence of abnormal cell morphology. - **Bone marrow biopsy** shows hypocellularity with fatty replacement, not the megaloblastic changes seen here. *Iron deficiency anemia* - Peripheral smear reveals **microcytic, hypochromic** RBCs with **pencil cells** and **target cells**. - **Low serum ferritin** and **elevated TIBC** would be characteristic, contrasting with the macrocytic findings in this case.

Q: What is the most common subtype of adult acute lymphoblastic leukemia (ALL)?

B-cell lineage ALL. **Explanation:** Acute Lymphoblastic Leukemia (ALL) is a malignant transformation of lymphoid progenitor cells. In adults, the distribution of subtypes differs slightly from children, but the overall predominance remains the same [1]. **1. Why B-cell lineage ALL is correct:** Approximately **75-80% of adult ALL cases** are of B-cell lineage [1]. This category encompasses the entire spectrum of B-cell development, from early pro-B to mature B-cells. Because it represents the vast majority of cases, it is classified as the most common subtype. **2. Why the other options are incorrect:** * **Pre-B-cell ALL:** While this is a specific stage within the B-cell lineage (characterized by cytoplasmic mu chains), it is a *subset* of B-cell ALL. The question asks for the broader lineage subtype. * **T-cell lineage ALL:** This accounts for only about **20-25%** of adult ALL cases [1]. It typically presents in younger males with a high white cell count and a mediastinal mass. * **Cortical T-ALL:** This is a specific immunophenotypic subcategory of T-ALL. While it often carries a slightly better prognosis than other T-cell subtypes, it is far less common than B-cell lineage ALL. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** The most common translocation in **adult B-ALL** is **t(9;22)**, the Philadelphia chromosome (BCR-ABL1), which carries a poor prognosis [1]. In contrast, children more commonly show t(12;21). * **Markers:** B-ALL typically expresses **CD19, CD20, and CD22** [1]. T-ALL expresses **CD2, CD3, CD5, and CD7**. * **Commonality:** ALL is the most common cancer in children, but in adults, it is less common than AML (Acute Myeloid Leukemia). * **Prognosis:** Adult ALL generally has a poorer prognosis compared to pediatric ALL [1].

Question 1

A 17-year-old woman's urine becomes red after being given sulfonamides for a urinary tract infection. Both urine and serum test positive for free hemoglobin, and the urine red cell count is 1.2 million/mm3. A peripheral blood smear shows normocytic and normochromic red cells and a few "bite cells." Deficiency of which of the following substances is most likely responsible for these symptoms?

Accepted Answer

Glucose-6-phosphate dehydrogenase

Answer

Alpha-chain of hemoglobin

Answer

Beta-chain of hemoglobin

Answer

Glycoprotein IIb/IIIa

Question 2

A 10-year-old child presents with anemia. Peripheral smear findings are shown below. What is the most probable type of anemia this child is suffering from?

Accepted Answer

Megaloblastic anemia

Answer

Hemolytic anemia

Answer

Aplastic anemia

Answer

Iron deficiency anemia

Question 3

The autohemolysis test is positive in which of the following conditions?

Accepted Answer

Hereditary spherocytosis

Answer

Beta thalassemia

Answer

Vitamin E deficiency

Answer

Sickle cell disease

Question 4

An 8-year-old African boy presents with swelling in his jaw and massive facial disfiguration. Biopsy reveals a tumor invading the bone marrow of the jaw. The pathogenesis of this malignant neoplasm is associated with a virus that exhibits a tropism for which of the following cells?

Accepted Answer

Lymphocytes

Answer

Chondrocytes

Answer

Fibroblasts

Answer

Macrophages

Question 5

All of the following are seen in paroxysmal nocturnal hemoglobinuria (PNH) except?

Accepted Answer

Arterial thrombosis

Answer

Venous thrombosis

Answer

Aplastic anemia

Answer

Hemolytic anemia

Question 6

What is the most common subtype of adult acute lymphoblastic leukemia (ALL)?

Accepted Answer

B-cell lineage ALL

Answer

Pre-B-cell ALL

Answer

T-cell lineage ALL

Answer

Cortical T-ALL

Question 7

Beta Thalassemia is best diagnosed by?

Accepted Answer

Hb electrophoresis

Answer

NESTROFT Test

Answer

HbA1c estimation

Answer

Target cells in peripheral smear

Question 8

Hereditary spherocytosis is characterized by what type of abnormality?

Accepted Answer

Membrane skeleton abnormalities

Answer

Microtubule defect

Answer

Accumulation of intermediate filament

Answer

None of the above

Question 9

Rate of sickling in sickle cell anemia is directly proportional to all of the following EXCEPT:

Accepted Answer

Raised HbF

Answer

Raised HbS

Answer

Raised HbC

Answer

Hb deoxygenation

Question 10

Progressive transformation of germinal centers (PTGC) is a precursor lesion of which of the following?

Accepted Answer

Hodgkin lymphoma, lymphocytic predominant

Answer

Hodgkin lymphoma, nodular sclerosis

Answer

Hodgkin lymphoma, mixed cellularity

Answer

Peripheral T cell lymphoma

Hematopathology — MCQs

Hematopathology — MCQs

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