Hematopathology Practice Questions

Q: In iron deficiency anemia, which of the following are seen in a peripheral blood smear?

High TIBC, Low Ferritin. ### Explanation Iron Deficiency Anemia (IDA) is characterized by a depletion of total body iron stores, leading to impaired hemoglobin synthesis. To understand the biochemical markers, one must look at the body's compensatory mechanisms. **1. Why Option B is Correct:** * **Low Ferritin:** Ferritin is the primary storage form of iron in the liver and reticuloendothelial system. In IDA, these stores are the first to be depleted to maintain serum iron levels. Therefore, a **low serum ferritin** is the most specific initial laboratory finding for IDA. * **High TIBC (Total Iron Binding Capacity):** TIBC is an indirect measure of **Transferrin**, the protein that transports iron. When iron stores are low, the liver increases the synthesis of transferrin to maximize the capture of any available iron. Thus, TIBC increases as the body attempts to compensate for the deficiency. **2. Why Other Options are Incorrect:** * **Options A & C (Low TIBC):** A low TIBC is typically seen in **Anemia of Chronic Disease (ACD)** or iron overload states. In ACD, inflammatory cytokines (like Hepcidin) sequester iron and downregulate transferrin production. * **Options C & D (High Ferritin):** High ferritin levels indicate iron overload (Hemochromatosis) or an acute phase response (inflammation/infection), which contradicts a deficiency state. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Bone marrow aspiration showing absent stainable iron (Prussian Blue/Perl’s stain). * **Earliest Sign:** Decreased serum ferritin. * **Peripheral Smear:** Microcytic hypochromic RBCs with increased **RDW** (Red Cell Distribution Width), pencil cells, and occasional target cells [1]. * **Mentzer Index:** (MCV/RBC count) >13 suggests IDA, while <13 suggests Thalassemia trait. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: Acute hemolytic transfusion reactions are typically caused by antibodies directed against which of the following blood group antigens?

All of the above. **Explanation:** Acute Hemolytic Transfusion Reactions (AHTR) occur when a recipient’s pre-existing antibodies (IgM or IgG) attack the donor’s red blood cells (RBCs) immediately or within 24 hours of transfusion [2]. This leads to intravascular or extravascular hemolysis. **Why "All of the above" is correct:** While **ABO incompatibility** is the most common and severe cause of AHTR (due to naturally occurring IgM antibodies), antibodies against **minor blood group antigens** can also trigger these reactions [1]. * **Rh system (Option A):** Anti-D, Anti-C, or Anti-E antibodies are potent triggers for hemolysis [1]. * **Kell system (Option B):** The K antigen is highly immunogenic; anti-K antibodies are a frequent cause of severe hemolytic reactions. * **Duffy system (Option C):** Anti-Fya and Anti-Fyb antibodies are known to cause both acute and delayed hemolytic reactions. Since antibodies against Rh, Kell, and Duffy antigens are all clinically significant and capable of causing acute hemolysis, "All of the above" is the most accurate choice. **Clinical Pearls for NEET-PG:** * **Most Common Cause of AHTR:** Clerical error leading to ABO incompatibility [2]. * **Mechanism:** Type II Hypersensitivity reaction. * **Classic Triad:** Fever/chills, flank pain, and hemoglobinuria (red/dark urine). * **Delayed Hemolytic Transfusion Reaction (DHTR):** Most commonly associated with the **Kidd (Jk)** blood group system. * **Duffy Antigen & Malaria:** The Duffy antigen serves as a receptor for *Plasmodium vivax*. Individuals who are Duffy-negative (common in African populations) are resistant to *P. vivax* infection. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 673-674.

Q: Which of the following subtypes of Hodgkin lymphoma has the strongest association with HIV?

Lymphocyte-depleted. The association between HIV and Hodgkin Lymphoma (HL) is unique. Unlike non-Hodgkin lymphoma, HL is not an AIDS-defining illness, but its incidence is significantly higher in HIV-positive individuals [1]. **Why Lymphocyte-depleted is correct:** In the setting of advanced HIV/AIDS, patients typically have severe immunosuppression and low CD4 counts. The **Lymphocyte-depleted (LD)** subtype is the rarest form of HL in the general population but is the **most strongly associated with HIV**. It is characterized by a paucity of lymphocytes and an abundance of Reed-Sternberg (RS) cells [1]. In HIV patients, HL often presents at an advanced stage (Stage III/IV), involves extranodal sites (bone marrow, liver), and is almost 100% associated with **Epstein-Barr Virus (EBV)**. Mixed Cellularity is the second most common subtype in HIV. **Analysis of Incorrect Options:** * **Nodular sclerosis:** This is the most common subtype of HL in the general population (especially young females). While it can occur in HIV patients, it does not have the strongest specific association with the virus. * **Lymphocyte-rich:** This subtype has a very good prognosis and is characterized by many reactive lymphocytes; it is rarely seen in the immunodeficient state of HIV. * **Nodular lymphocyte-predominant (NLPHL):** This is a distinct clinical entity (CD20+) and is generally not associated with EBV or HIV infection. **High-Yield Pearls for NEET-PG:** * **Most common HL subtype in HIV:** Mixed Cellularity (historically) or Nodular Sclerosis (in the HAART era), but **LD** has the strongest *relative* association. * **EBV Association:** Nearly all HL cases in HIV patients are EBV-positive. * **Prognosis:** HL in HIV patients is more aggressive, presents with B-symptoms, and has a poorer prognosis compared to HIV-negative patients. * **CD4 Count:** Unlike NHL, HL often occurs when CD4 counts are relatively preserved (often >200 cells/mm³).

Question 1

Neutropenia is not a feature of which of the following conditions?

Accepted Answer

Congenital asplenia

Answer

Wiskott-Aldrich syndrome

Answer

Kostmann syndrome

Answer

X-linked hyper-IgM syndrome

Question 2

In iron deficiency anemia, which of the following are seen in a peripheral blood smear?

Accepted Answer

High TIBC, Low Ferritin

Answer

Low TIBC, Low Ferritin

Answer

Low TIBC, High Ferritin

Answer

High TIBC, High Ferritin

Question 3

A 14-year-old boy presents with gingival bleeding, oral ulcers, anemia, hepatomegaly, and no lymphadenopathy. His total leukocyte count is one lakh cells per mm³. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Chronic monocytic leukemia

Answer

Chronic lymphoblastic leukemia

Answer

Chronic myeloid leukemia

Question 4

Cryoprecipitate contains which of the following components?

Accepted Answer

Antithrombin

Answer

Fibrinogen

Answer

Factor VIII

Answer

Von Willebrand factor

Question 5

Acute hemolytic transfusion reactions are typically caused by antibodies directed against which of the following blood group antigens?

Accepted Answer

All of the above

Answer

Rh

Answer

Kell

Answer

Duffy

Question 6

A 55-year-old male presents with renal failure, bone pain for 7 years, and osteolytic lesions on X-ray. Serum electrophoresis shows an M spike and 35% plasma cells with aberrant protein expression. What is the diagnosis?

Accepted Answer

Multiple myeloma

Answer

MGUS

Answer

Smoldering myeloma

Answer

Plasma cell leukemia

Question 7

High mitotic activity with rapid cellular turnover and characteristic "Starry sky" appearance is seen in which of the following conditions?

Accepted Answer

Burkitt's lymphoma

Answer

Follicular lymphoma

Answer

Diffuse lymphoma

Answer

Hodgkin's lymphoma

Question 8

A patient being investigated for anemia has a dry marrow tap. Peripheral smear reveals tear drop cells. What is the likely diagnosis?

Accepted Answer

Myelofibrosis

Answer

Leukemia

Answer

Lymphoma

Answer

Polycythemia rubra vera

Question 9

Which one of the following platelet counts is usually associated with an increased incidence of spontaneous bleeding?

Accepted Answer

Less than 20,000/mm³

Answer

Greater than 80,000/mm³

Answer

40,000/mm³

Answer

20,000/mm³

Question 10

Which of the following subtypes of Hodgkin lymphoma has the strongest association with HIV?

Accepted Answer

Lymphocyte-depleted

Answer

Lymphocyte-rich

Answer

Nodular lymphocyte-predominant

Answer

Nodular sclerosis

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?