Hematopathology Practice Questions

Q: Peripheral smear of a neonate with ABO incompatibility typically shows which of the following?

Microspherocytes. **Explanation:** In **ABO Incompatibility**, the presence of **Microspherocytes** on a peripheral smear is a hallmark finding. This occurs because maternal IgG antibodies (anti-A or anti-B) cross the placenta and bind to the neonate’s RBCs. Splenic macrophages then "nibble" away portions of the antibody-coated RBC membrane. The cell loses surface area but retains its volume, forcing it to assume a spherical shape (spherocyte) which is smaller and lacks central pallor. **Analysis of Options:** * **A. Microspherocytes (Correct):** Characteristic of ABO incompatibility. Note that spherocytes are typically **absent** in Rh incompatibility, making this a key differentiating feature. * **B. Elliptocytes:** These are cigar-shaped cells seen in Hereditary Elliptocytosis or iron deficiency anemia, not immune-mediated hemolysis. * **C. Fragmented RBCs (Schistocytes):** These indicate microangiopathic hemolytic anemia (MAHA), such as DIC or HUS, caused by mechanical shearing of RBCs. * **D. Polychromasia:** While polychromasia (representing reticulocytosis) is seen in ABO incompatibility due to the bone marrow's response to hemolysis, it is a **non-specific** finding seen in any hemolytic state. Microspherocytes are the more specific diagnostic clue for ABO disease. **NEET-PG High-Yield Pearls:** 1. **ABO vs. Rh:** ABO incompatibility can occur in the **first pregnancy** (unlike Rh) because anti-A/B antibodies are naturally occurring. 2. **Direct Coombs Test (DCT):** In ABO incompatibility, the DCT is often **weakly positive or negative**, whereas in Rh incompatibility, it is strongly positive. 3. **Blood Groups:** Most commonly occurs when the mother is **O** and the baby is **A or B**. 4. **Clinical Presentation:** Usually presents as mild jaundice within the first 24 hours of life. Severe hydrops is rare compared to Rh disease.

Q: Which of the following is the most sensitive indicator for the detection of iron depletion in pregnancy?

Serum ferritin. **Explanation:** **Serum ferritin** is the most sensitive and specific laboratory indicator for detecting iron depletion in pregnancy. It reflects the total body iron stores. In the early stages of iron deficiency (the "pre-latent" phase), ferritin levels drop before any changes occur in serum iron or hemoglobin levels. A serum ferritin level of **<15–30 µg/L** is diagnostic of depleted iron stores, even in the absence of anemia. **Analysis of Incorrect Options:** * **Serum iron (A):** This measures the iron currently bound to transferrin. It is a poor indicator because it fluctuates significantly based on recent dietary intake and shows diurnal variation. * **Serum transferrin (B):** Transferrin (measured via Total Iron Binding Capacity - TIBC) increases during iron deficiency. However, it is less sensitive than ferritin because it only rises significantly once iron stores are already exhausted. * **Serum erythropoietin (C):** This hormone increases in response to hypoxia or significant anemia to stimulate RBC production. It is not a specific or sensitive marker for iron stores. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** Bone marrow aspiration (Prussian blue staining) is the gold standard for assessing iron stores, but **Serum Ferritin** is the investigation of choice (most sensitive non-invasive test). * **The "Rule of 3" in Pregnancy:** * Hb < 11 g/dL (1st & 3rd Trimester) or < 10.5 g/dL (2nd Trimester) defines anemia. * Daily elemental iron requirement: **4–6 mg**. * Prophylactic dose (IFA): **60 mg** elemental iron + **500 µg** folic acid for 180 days. * **Note:** Ferritin is an acute-phase reactant; its levels may be falsely elevated in the presence of systemic infection or inflammation.

Question 1

A normotensive patient with normal hemoglobin suffered massive blood loss. The following findings could be expected, except:

Accepted Answer

Increased PCV

Answer

Increased MCV

Answer

Thrombocytosis

Answer

Reticulocytosis

Question 2

A 42-year-old man sustained severe injuries in an automobile accident and is admitted to the intensive care unit. Examination of a peripheral blood smear on the 3rd day of admission reveals helmet cells, schistocytes, and decreased platelets. Which of the following is most strongly suggested by these findings?

Accepted Answer

Disseminated intravascular coagulation (DIC)

Answer

Autoimmune hemolysis

Answer

Hereditary spherocytosis

Answer

Megaloblastic anemia

Question 3

Which of the following is true about beta-thalassemia trait?

Accepted Answer

All of the above

Answer

Increased HbF

Answer

Increased HbA2

Answer

Microcytosis

Question 4

Histologic sections of the thymus that reveal reactive follicles with germinal centers are diagnostic of what condition?

Accepted Answer

Thymic hyperplasia

Answer

Acute inflammation

Answer

Chronic inflammation

Answer

Thymic hypoplasia

Question 5

Peripheral smear of a neonate with ABO incompatibility typically shows which of the following?

Accepted Answer

Microspherocytes

Answer

Elliptocytes

Answer

Fragmented RBCs

Answer

Polychromasia

Question 6

A 20-year-old male presents in the emergency room with a lymphoma involving the mediastinum that is producing respiratory distress. The lymphocytes are most likely to have cell surface markers characteristic of which of the following?

Accepted Answer

T lymphocytes

Answer

B lymphocytes

Answer

Macrophages

Answer

Langerhans cells

Question 7

Which of the following is the most sensitive indicator for the detection of iron depletion in pregnancy?

Accepted Answer

Serum ferritin

Answer

Serum iron

Answer

Serum transferrin

Answer

Serum erythropoietin

Question 8

A 30-month-old boy presents with jaundice and pallor. Investigations reveal anemia, reticulocytosis, and increased indirect bilirubin. A peripheral blood smear shows red blood cells without central pallor. What additional findings are most likely in this patient?

Accepted Answer

Increased mean corpuscular hemoglobin concentration

Answer

Decreased lactate dehydrogenase

Answer

Increased mean corpuscular volume

Answer

Red blood cell inclusions

Question 9

Both beta chains of haemoglobin are abnormal in which of the following conditions?

Accepted Answer

Thalassemia major

Answer

Heterozygous sickle cell trait

Answer

Homozygous sickle cell anemia

Answer

Megaloblastic anemia

Question 10

A middle-aged man presents with a markedly enlarged tonsil and recurrent infections with serum immunoglobulin deficiency. Chromosome analysis demonstrates a translocation between the immunoglobulin heavy chain locus on chromosome 14 and an unidentified gene on chromosome 8. Which of the following is the most likely cause of his phenotype?

Accepted Answer

The translocation has activated a tumor-promoting gene on chromosome 8.

Answer

The translocation has deleted constant chain exons on chromosome 14 and prevented heavy chain class switching.

Answer

The translocation has deleted the interval containing diversity, and joining regions.

Answer

The translocation has deleted the heavy chain constant chain Cu so that virgin B cells cannot produce IgM on their membranes.

Hematopathology — MCQs

Hematopathology — MCQs

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