Hematopathology Practice Questions

Q: Which anticoagulant is used in coagulation studies?

Trisodium citrate. **Explanation:** **Trisodium citrate (3.2%)** is the anticoagulant of choice for coagulation studies (PT, APTT, and Fibrinogen levels). It works by **chelating calcium ions**, which are essential cofactors in the coagulation cascade. It is preferred because its action is easily reversible by adding calcium back to the plasma during testing. For accurate results, a precise **blood-to-anticoagulant ratio of 9:1** must be maintained; underfilling the tube leads to excess citrate, which falsely prolongs clotting times [1]. **Why other options are incorrect:** * **EDTA (Ethylenediaminetetraacetic acid):** While it is a potent calcium chelator, it is unsuitable for coagulation studies because it irreversibly inhibits certain clotting factors (like Factor V and VIII) and interferes with the end-point detection of fibrin formation. It is primarily used for CBC and peripheral smears. * **Calcium citrate:** This is not an anticoagulant; in fact, adding calcium to citrated plasma is the standard way to initiate the clotting process in a laboratory setting. * **Sodium bromide:** This has no role as a clinical anticoagulant. Historically, bromides were used as sedatives or antiepileptics. **High-Yield Clinical Pearls for NEET-PG:** * **Tube Color:** Trisodium citrate is found in the **Light Blue** top tube. * **Concentration:** 3.2% (0.109 mol/L) is the standard recommendation by the CLSI. * **Polycythemia Correction:** If a patient’s hematocrit is **>55%**, the volume of citrate must be adjusted (decreased) because there is less plasma relative to the anticoagulant, which can cause falsely elevated PT/APTT [1]. * **Platelet Function:** Citrate is also used for Platelet Aggregation Studies. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 625-626.

Question 1

A patient presents with splenomegaly, low RBC count, normal WBC and platelet count, and peripheral blood smear shows target cells. Repeated bone marrow aspiration is unsuccessful. What is the probable diagnosis?

Accepted Answer

Myelofibrosis

Answer

Thalassemia

Answer

Chronic myeloid leukemia

Answer

Iron deficiency anemia

Question 2

Which anticoagulant is used in coagulation studies?

Accepted Answer

Trisodium citrate

Answer

Calcium citrate

Answer

EDTA

Answer

Sodium bromide

Question 3

A 60-year-old male patient presents with complaints of weakness and abdominal pain. General physical examination reveals marked splenomegaly and moderate hepatomegaly. Histopathologic findings are suggestive of leukoerythroblastosis. What condition is this patient most likely suffering from?

Accepted Answer

Primary myelofibrosis

Answer

Intestinal infarction

Answer

Sickle cell anemia

Answer

Chronic myeloid leukemia

Question 4

Mean corpuscular hemoglobin concentration (MCHC) is normal in all of the following conditions except?

Accepted Answer

Iron deficiency anemia

Answer

Megaloblastic anemia

Answer

Hemolytic anemia

Answer

Aplastic anemia

Question 5

Schistocyte is/are found in:

Accepted Answer

All of the above

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

March hemoglobinuria

Answer

Severe iron deficiency anemia

Question 6

What is the Philadelphia chromosome?

Accepted Answer

Chromosome 9-22 translocation

Answer

Chromosome 5-9 translocation

Answer

An absent marker indicating a bad prognosis

Answer

A prognostic factor in Acute Lymphoblastic Leukemia (ALL)

Question 7

A WBC count of more than 1,00,000 cells/cc of blood indicates which of the following?

Accepted Answer

Leukemia

Answer

Leukopenia

Answer

Leukoplakia

Answer

Leukocytosis

Question 8

Mutation of which of the following genes is most important in paroxysmal nocturnal hemoglobinuria?

Accepted Answer

Glycosyl phosphatidyl inositol (GPI)

Answer

Decay accelerating factor (DAF)

Answer

Membrane inhibitor of reactive lysis (MIRL)

Answer

CD8 binding protein

Question 9

Increased bleeding time is seen in all of the following conditions except:

Accepted Answer

Hemophilia

Answer

Thrombocytopenia

Answer

Von Willebrand disease

Answer

Ehlers-Danlos syndrome

Question 10

Which of the following cells are involved in the process of efferocytosis?

Accepted Answer

Macrophages

Answer

T lymphocytes

Answer

B lymphocytes

Answer

NK cells

Hematopathology — MCQs

Hematopathology — MCQs

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