Hematopathology Practice Questions

Q: What is the best marker for iron deficiency?

Serum ferritin. **Explanation:** **Serum ferritin** is considered the most reliable and sensitive biochemical marker for diagnosing iron deficiency. Ferritin is the primary intracellular storage protein for iron. Since serum ferritin levels are directly proportional to total body iron stores, a low level is highly specific for iron deficiency anemia (IDA), often decreasing before changes in hemoglobin or red cell morphology occur. [1] **Analysis of Incorrect Options:** * **Serum Iron:** This measures the amount of iron circulating in the blood bound to transferrin. It is a poor marker because it fluctuates significantly throughout the day (diurnal variation) and can be affected by recent dietary intake or infection. * **Total Iron Binding Capacity (TIBC):** This measures the blood's capacity to bind iron with transferrin. While TIBC increases in iron deficiency, it is an indirect measure and can be influenced by liver function and nutritional status (e.g., pregnancy or oral contraceptives). * **Transferrin Saturation:** This is the ratio of serum iron to TIBC. While it decreases in IDA, it is less sensitive than ferritin because it relies on serum iron levels, which are inherently unstable. **NEET-PG High-Yield Pearls:** * **Gold Standard:** While serum ferritin is the best *non-invasive* test, the absolute gold standard for assessing iron stores is a **Bone Marrow Aspiration** (Prussian Blue staining), though it is rarely performed for simple IDA. * **The "Acute Phase" Caveat:** Ferritin is an **acute-phase reactant**. In the presence of inflammation, malignancy, or liver disease, ferritin levels may be falsely elevated even if the patient is iron deficient. * **Early Marker:** The very first biochemical change in developing iron deficiency is a **decrease in serum ferritin**. [1]

Q: Which of the following is not associated with a high reticulocyte count?

Megaloblastic anemia. The **Reticulocyte Count** is a direct reflection of the bone marrow's erythropoietic activity. A high count (reticulocytosis) indicates that the marrow is healthy and responding to a decrease in red blood cells (RBCs) or a stimulus like erythropoietin. **Why Megaloblastic Anemia is the Correct Answer:** Megaloblastic anemia (caused by Vitamin B12 or Folate deficiency) is characterized by **ineffective erythropoiesis** [1]. Although the bone marrow is hypercellular, the RBC precursors die within the marrow due to defective DNA synthesis. Consequently, the marrow cannot release mature cells or reticulocytes into the peripheral blood, leading to a **low reticulocyte count** (reticulocytopenia) [1]. **Analysis of Incorrect Options:** * **Acute Bleed:** Following a sudden loss of blood, the body increases erythropoietin production, stimulating a healthy marrow to release young RBCs (reticulocytes) within 3–5 days to compensate. * **Hemolytic Anemia:** In conditions like G6PD deficiency or Hereditary Spherocytosis, RBCs are destroyed prematurely. The marrow remains functional and compensates by significantly increasing reticulocyte production. * **Response to Treatment:** When a nutritional deficiency (Iron, B12, or Folate) is treated, the "block" in RBC production is removed, leading to a "reticulocyte flare" (usually peaking at 5–10 days), signaling a positive response to therapy. **NEET-PG High-Yield Pearls:** * **Corrected Reticulocyte Count (CRC):** In anemia, always use CRC [% Retic × (Patient Hct / Normal Hct)] to assess marrow response accurately. * **Reticulocyte Production Index (RPI):** An RPI > 2% indicates an adequate marrow response (Hemolysis/Hemorrhage); an RPI < 2% indicates an inadequate response (Hypoproliferative/Megaloblastic anemias). * **Supravital Stains:** Reticulocytes are visualized using **New Methylene Blue** or **Brilliant Cresyl Blue**, which stain the residual ribosomal RNA.

Q: All of the following statements regarding pathological inclusions are true EXCEPT?

Cabot rings occur in iron deficiency anemia.. **Explanation:** The correct answer is **C**. **Cabot rings** are thin, red-purple, thread-like strands found in the shape of a loop or figure-of-eight within erythrocytes. They are remnants of the **mitotic spindle** (microtubules), not iron. While they are seen in megaloblastic anemia, lead poisoning, and myelodysplastic syndromes, they are **not** a characteristic feature of iron deficiency anemia. **Analysis of other options:** * **A. Howell-Jolly bodies:** These are small, round, purple nuclear remnants (DNA). Normally, the spleen’s "pitting" function removes them [1]. Therefore, they are classic markers of **splenectomy** or functional asplenia (e.g., Sickle Cell Anemia) [2]. * **B. Basophilic stippling:** This represents coarse or fine blue granules (precipitated **ribosomes/RNA**). It is a hallmark of **lead poisoning** (due to inhibition of pyrimidine 5'-nucleotidase) and is also seen in thalassemias and sideroblastic anemia. * **D. Heinz bodies:** These are inclusions of **denatured hemoglobin** [1]. While most commonly associated with **G6PD deficiency** (oxidative stress), they are also seen in **thalassemias** due to the precipitation of excess globin chains [1]. **NEET-PG High-Yield Pearls:** * **Pappenheimer bodies:** Siderotic granules (iron) seen in Sideroblastic anemia; confirmed with **Prussian Blue stain**. * **Heinz bodies** require **Supravital stains** (Crystal violet/Methylene blue) to be visualized; they are not seen on routine Leishman/Wright stains [1]. * **Bite cells (Degmacytes):** Result from splenic macrophages plucking out Heinz bodies [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 642-654. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 652-654.

Question 1

All are seen in Thalassemia major EXCEPT?

Accepted Answer

Macrocytic anemia

Answer

Transfusion dependency

Answer

Hepato-splenomegaly

Answer

Target cells

Question 2

What is the most common cause of Hereditary Spherocytosis?

Accepted Answer

Ankyrin

Answer

Spectrin

Answer

Glycophorin

Answer

Band 4

Question 3

The peripheral smear of hereditary spherocytosis will typically show spherocytes. What is the characteristic size of these spherocytes compared to normal red blood cells?

Accepted Answer

Smaller size than RBCs

Answer

Usually of the same size as RBCs

Answer

Reticulocytosis is absent

Answer

Anemia is negligible

Question 4

What is the best marker for iron deficiency?

Accepted Answer

Serum ferritin

Answer

Serum iron

Answer

Total iron binding capacity

Answer

Transferrin saturation

Question 5

The Hodgkin lymphoma subtype that particularly involves the anterior mediastinum is:

Accepted Answer

Nodular sclerosing

Answer

Lymphocyte predominant

Answer

Lymphocyte depleted

Answer

Mixed cellularity

Question 6

Which of the following is not associated with a high reticulocyte count?

Accepted Answer

Megaloblastic anemia

Answer

Acute bleed

Answer

Hemolytic anemia

Answer

Response to treatment in nutrition deficiency anemia

Question 7

All of the following statements regarding pathological inclusions are true EXCEPT?

Accepted Answer

Cabot rings occur in iron deficiency anemia.

Answer

Howell-Jolly bodies occur in splenectomized patients.

Answer

Basophilic stippling is seen in lead intoxication.

Answer

Heinz bodies are seen in thalassemia.

Question 8

A 15-year-old boy presented with anemia and jaundice. On examination, his hemoglobin was 6 g/dL, USG showed gallstones, and the peripheral smear showed bite cells. What is the most likely diagnosis?

Accepted Answer

Hereditary ovalocytosis

Answer

Hereditary acanthocytosis

Answer

Hereditary spherocytosis

Answer

Hereditary xerocytosis

Question 9

Castleman's disease is associated with a defect in which of the following interleukins?

Accepted Answer

Interleukin 6 (IL-6)

Answer

Interleukin 1 (IL-1)

Answer

Interleukin 4 (IL-4)

Answer

Interleukin 8 (IL-8)

Question 10

Autopsy of the spleen of a patient with portal hypertension shows Gamna-Gandy bodies. These bodies are characterized by the presence of hemosiderin and which of the following?

Accepted Answer

Calcium ions (Ca++)

Answer

Sodium ions (Na+)

Answer

Magnesium ions (Mg++)

Answer

Calcium (Ca)

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?