Hematopathology Practice Questions

Q: Which of the following tests is used to screen a woman with a family history of thalassemia?

NESTROFT. **Explanation:** The correct answer is **NESTROFT** (Naked Eye Single Tube Red Cell Osmotic Fragility Test). **1. Why NESTROFT is correct:** In resource-limited settings and large-scale population screening (especially for Thalassemia Trait), NESTROFT is the preferred **screening test**. It is based on the principle of osmotic fragility. Thalassemic red cells are microcytic and hypochromic with a high surface-area-to-volume ratio, making them more resistant to hemolysis in hypotonic saline (0.36%) compared to normal cells. If the solution remains turbid (cannot see a black line through the tube), the test is positive, indicating a high probability of Thalassemia Trait. It is cost-effective, rapid, and has high sensitivity. **2. Why other options are incorrect:** * **Hb A2 Levels:** This is the **Gold Standard for diagnosis** of Beta-Thalassemia Trait (values >3.5%). However, it is an expensive and specialized test, making it unsuitable for initial mass screening. * **High Performance Liquid Chromatography (HPLC):** This is the **confirmatory test** used to quantify HbA2, HbF, and detect abnormal hemoglobin variants. It is the "investigation of choice" for definitive diagnosis, not primary screening. * **Peripheral Smear and Reticulocyte Count:** While a smear shows microcytic hypochromic cells and target cells, it is non-specific and cannot differentiate between Iron Deficiency Anemia (IDA) and Thalassemia. **Clinical Pearls for NEET-PG:** * **Mentzer Index:** (MCV/RBC count) 13 suggests IDA. * **Best Screening Test:** NESTROFT. * **Investigation of Choice/Confirmatory Test:** HPLC. * **Target Cells:** Characteristically seen in Thalassemia, Liver disease, and Post-splenectomy.

Q: Which one of the following is the most common immunologic type of multiple myeloma?

IgG, Kappa light chain. **Explanation:** Multiple myeloma is a neoplastic proliferation of plasma cells that secrete a monoclonal (M) protein [1]. The classification of myeloma is based on the type of heavy chain and light chain produced. **1. Why Option A is Correct:** The most common heavy chain produced in multiple myeloma is **IgG** (found in approximately 50–60% of cases), followed by IgA [1]. Regarding light chains, **Kappa (κ)** is more common than Lambda (λ), occurring in a ratio of approximately 2:1. Therefore, **IgG-Kappa** is the most frequent immunologic subtype encountered in clinical practice. **2. Analysis of Incorrect Options:** * **Option B (IgA, Kappa):** This is the second most common heavy chain type (approx. 20–25% of cases) [1]. While common, it is significantly less frequent than the IgG type. * **Option C (IgD, Lambda):** IgD myeloma is rare (less than 2%) [1]. Interestingly, IgD myeloma is a unique exception where **Lambda** light chains are more common than Kappa, but it remains an uncommon subtype overall. * **Option D (IgM type):** IgM production is characteristic of **Waldenström Macroglobulinemia**, not Multiple Myeloma [1]. True IgM myeloma is extremely rare. **High-Yield Clinical Pearls for NEET-PG:** * **Bence-Jones Proteins:** These represent free light chains excreted in the urine [1]. * **M-Spike:** On Serum Protein Electrophoresis (SPEP), the monoclonal protein typically appears as a sharp spike in the **gamma-globulin** region. * **CRAB Criteria:** Remember the classic presentation: **C**alcium elevation, **R**enal insufficiency, **A**nemia, and **B**one lesions (lytic "punched-out" lesions). * **Diagnosis:** Plasma cells >10% on bone marrow biopsy is a key diagnostic criterion. **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. 608-609.

Q: A 25-year-old female presented with chronic fatigue, cyanosis with bluish lips, and arthralgia. A peripheral blood film is shown below. What is the likely cause?

Cold AIHA. ***Cold AIHA*** - **Red cell agglutination** on peripheral smear combined with **cyanosis** (bluish lips) and **arthralgia** forms the classic triad of cold autoimmune hemolytic anemia. - **IgM cold agglutinins** cause red cells to clump together at lower temperatures, leading to **vascular occlusion** and cyanosis in extremities. *Warm AIHA* - Typically shows **spherocytes** on peripheral smear rather than red cell agglutination or clumping. - **IgG antibodies** cause hemolysis at body temperature but do not produce the **cold-induced cyanosis** seen in this case. *Hemoglobinopathy* - Would show characteristic red cell morphology like **sickle cells** (sickle cell disease) or **target cells** (thalassemia). - Does not typically cause **red cell agglutination** or the specific combination of cyanosis with arthralgia. *G6PD Deficiency* - Peripheral smear would show **bite cells** and **Heinz bodies** during hemolytic episodes triggered by oxidative stress. - Does not cause **red cell agglutination** and typically presents with episodic hemolysis rather than chronic cyanosis.

Question 1

Testing of recipient cells against donor serum is:

Accepted Answer

Minor Crossmatching

Answer

Major Cross Matching

Answer

Direct Coomb's Test

Answer

Rh Group Matching

Question 2

Which of the following tests is used to screen a woman with a family history of thalassemia?

Accepted Answer

NESTROFT

Answer

Hb A2 Levels

Answer

High performance liquid chromatography

Answer

Peripheral smear and reticulocyte count

Question 3

Which one of the following is the most common immunologic type of multiple myeloma?

Accepted Answer

IgG, Kappa light chain

Answer

IgA, Kappa light chain

Answer

IgD, Lambda light chain

Answer

IgM, type

Question 4

Which of the following is associated with an intrinsic defect in the RBC membrane?

Accepted Answer

Hereditary spherocytosis

Answer

Autoimmune hemolytic anemia

Answer

Microangiopathic hemolytic anemia

Answer

Thermal injury anemia

Question 5

Massive transfusions result in which of the following complications?

Accepted Answer

Disseminated intravascular coagulation (DIC), Hypothermia, Hypercalcemia

Answer

Disseminated intravascular coagulation (DIC), Hypothermia, Thrombocytopenia

Answer

Disseminated intravascular coagulation (DIC), Hypercalcemia, Thrombocytopenia

Answer

Hypothermia, Hypercalcemia, Thrombocytopenia

Question 6

A 48-year-old woman presented with a two-month history of weakness. On examination, cervical lymph nodes were enlarged, and the spleen was palpable 2 cm below the costal margin. The platelet count was 237 x 10^9/L and the total leukocyte count was 40 x 10^9/L, with coarse clumped chromatin noted. Bone marrow revealed a nodular lymphoid infiltrate. Peripheral blood lymphoid cells were negative for CD19, CD5, CD20, and CD23, and also negative for CD79B and FMC-7. What is the most likely diagnosis?

Accepted Answer

Chronic lymphocytic leukemia

Answer

T-cell rich B-cell lymphoma with leukemic spillover in blood.

Answer

Mantle cell lymphoma

Answer

A definite diagnosis cannot be made in this patient without a lymph node biopsy.

Question 7

Which of the following is NOT a good prognostic factor for Acute Myeloid Leukemia (AML)?

Accepted Answer

Acute megakaryoblastic leukemia (AMkL)

Answer

Age less than 2 years

Answer

Acute promyelocytic leukemia (APL)

Answer

Associated with Down syndrome

Question 8

All of the following statements about Fanconi's anemia are true, EXCEPT?

Accepted Answer

Autosomal dominant inheritance

Answer

Hypocellular Bone Marrow

Answer

Congenital Anomalies

Answer

Usually normocytic / macrocytic cell morphology

Question 9

A 25-year-old female presented with chronic fatigue, cyanosis with bluish lips, and arthralgia. A peripheral blood film is shown below. What is the likely cause?

Accepted Answer

Cold AIHA

Answer

Warm AIHA

Answer

Hemoglobinopathy

Answer

G6PD Deficiency

Question 10

All of the following are true about blood transfusion protocols EXCEPT:

Accepted Answer

Blood transfusions should commence within 60 minutes of removing the blood bag from refrigeration.

Answer

Whole blood or packed red blood cells must be transfused within 4 hours.

Answer

Transfusion sets should include a standard filter of 170 micrometers.

Answer

The usual needle size for blood transfusion is 18-19 gauge.

Hematopathology — MCQs

Hematopathology — MCQs

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