Hematopathology Practice Questions

Q: Which of the following statements is true regarding single-donor platelet transfusion?

Equivalent to 6-8 units of random-donor platelets. **Explanation:** **1. Why Option A is Correct:** A Single-Donor Platelet (SDP) unit is prepared via apheresis from a single individual [1]. One unit of SDP typically contains $\geq 3 \times 10^{11}$ platelets. In contrast, a unit of Random-Donor Platelets (RDP) contains approximately $5.5 \times 10^{10}$ platelets. Therefore, one SDP unit provides a platelet yield equivalent to **6–8 units of RDP**. Clinically, one SDP unit is expected to raise the adult recipient's platelet count by 30,000–60,000/L. **2. Why the Other Options are Incorrect:** * **Option B:** Platelets must be stored at **room temperature (20–24C)** with continuous agitation to maintain viability and prevent "storage lesion." Storage at 2–6C (refrigeration) is reserved for Red Blood Cells and causes irreversible platelet dysfunction. * **Option C:** Platelets have a short shelf life of only **5 days** due to the risk of bacterial overgrowth at room temperature. * **Option D:** In modern transfusion medicine, leukodepletion is ideally performed **pre-storage** (at the blood bank) rather than at the bedside. Pre-storage leukoreduction is more efficient at preventing Febrile Non-Hemolytic Transfusion Reactions (FNHTR) and HLA alloimmunization. **3. High-Yield Clinical Pearls for NEET-PG:** * **Dose:** 1 unit of RDP increases platelet count by 5,000–10,000/L. * **Indication:** Prophylactic transfusion is generally indicated when the platelet count falls below **10,000/L** in stable patients. * **Advantage of SDP:** Reduced risk of HLA alloimmunization and lower risk of transfusion-transmitted infections (TTIs) due to limited donor exposure [1]. * **Contraindication:** Platelet transfusions are generally contraindicated in **TTP (Thrombotic Thrombocytopenic Purpura)** and **HIT (Heparin-Induced Thrombocytopenia)** as they may fuel the prothrombotic state.

Q: Which of the following is NOT part of the triad of hairy cell leukemia?

Erythema nodosum. **Explanation:** Hairy Cell Leukemia (HCL) is a rare, chronic B-cell lymphoproliferative disorder characterized by the classic clinical triad of **Splenomegaly, Pancytopenia, and "Dry Tap" on bone marrow aspiration.** [1] 1. **Why Erythema Nodosum is correct:** Erythema nodosum is a form of panniculitis (inflammation of fat cells under the skin) associated with infections (Streptococcal, TB), Sarcoidosis, or Inflammatory Bowel Disease. It is **not** a feature of HCL. 2. **Why the other options are part of HCL:** * **Splenomegaly:** This is the most common physical finding (often massive) due to the infiltration of the red pulp by "hairy" cells [1]. Notably, lymphadenopathy is usually absent. * **Pancytopenia:** Resulting from bone marrow infiltration and splenic sequestration [1]. Monocytopenia is a highly specific hallmark of HCL. * **Hypercellular marrow (with fibrosis):** While the marrow is often hypercellular with a characteristic "fried egg" appearance (cells with abundant cytoplasm and distinct borders), the increased reticulin fibrosis leads to a **"Dry Tap"** during aspiration [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** B-cells with hair-like cytoplasmic projections [1]. * **Cytochemistry:** **TRAP positive** (Tartrate-Resistant Acid Phosphatase). * **Immunophenotype:** Positive for **CD11c, CD25, CD103**, and CD123. * **Genetic Mutation:** **BRAF V600E** mutation is seen in almost all cases. * **Treatment:** Cladribine (2-CdA) is the drug of choice. * **Biopsy Finding:** "Fried egg" appearance in the bone marrow and "Beefy red" appearance of the spleen [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 610-612.

Question 1

Which of the following conditions is NOT typically associated with a lymphatic leukemoid reaction?

Accepted Answer

Lobar Pneumonia

Answer

Tuberculosis

Answer

Pertussis

Answer

Viral infections

Question 2

Which of the following statements is not true regarding Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)?

Accepted Answer

Transformation to Richter syndrome is commonly seen.

Answer

The tumor cells are positive for CD5 and CD20.

Answer

ZAP-70 expression is a poor prognostic marker.

Answer

Proliferation centers in lymph nodes are pathognomonic.

Question 3

Post-transfusion hepatitis is most commonly associated with which component?

Accepted Answer

Packed red blood cells

Answer

Platelets

Answer

Whole blood

Answer

Albumin

Question 4

What is the most specific investigation in disseminated intravascular coagulation?

Accepted Answer

D-dimer assay

Answer

Bleeding time

Answer

Clotting time

Answer

Fibrinogen level

Question 5

Which of the following statements is true regarding single-donor platelet transfusion?

Accepted Answer

Equivalent to 6-8 units of random-donor platelets

Answer

Stored at 2-6 degrees Celsius

Answer

Has a shelf life of 10 days

Answer

Leukodepletion is performed at the bedside

Question 6

Which of the following features cannot be used to differentiate between Hodgkin's lymphoma and Non-Hodgkin's lymphoma?

Accepted Answer

Painless lymphadenopathy

Answer

Extranodal involvement

Answer

Contiguous spread

Answer

Localization to a particular group of lymph nodes

Question 7

Which of the following is NOT part of the triad of hairy cell leukemia?

Accepted Answer

Erythema nodosum

Answer

Splenomegaly

Answer

Pancytopenia

Answer

Hypercellular marrow

Question 8

Which of the following are common features of hemolytic anemia?

Accepted Answer

Decreased RBC life span, Unconjugated hyperbilirubinemia, Altered erythroid and myeloid ratio

Answer

Decreased RBC life span, Unconjugated hyperbilirubinemia, Bile salt and bile pigments in urine

Answer

Unconjugated hyperbilirubinemia, Bile salt and bile pigments in urine, Altered erythroid and myeloid ratio

Answer

Decreased RBC life span, Bile salt and bile pigments in urine, Altered erythroid and myeloid ratio

Question 9

Which of the following is NOT true regarding Langerhans Cell Histiocytosis (LCH)?

Accepted Answer

CD-68 positive

Answer

Papular trunk lesions with scaling and crusting

Answer

Ulcerative nodules on mucosa

Answer

Calvarial defect with map lesions and floating teeth

Question 10

A 12-year-old male presented with a history of recurrent nose bleeds, easy bruising, frequent muscle hematoma formation, and prolonged bleeding following trivial trauma. On examination, certain skin lesions were seen along with jaundice, splenomegaly, lymphadenopathy, and joint and skin laxity. Lab findings revealed normal PT, prolonged aPTT, reduced ristocetin cofactor activity, and a normal factor VIII assay, normal platelet count and size, and normal platelet granules. What is the most probable diagnosis of the above condition?

Accepted Answer

von Willebrand disease

Answer

Bernard-Soulier syndrome

Answer

Hemophilia A

Answer

Platelet function defect

Hematopathology — MCQs

Hematopathology — MCQs

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