Hematopathology Practice Questions

Q: All are true about anemia of chronic disease, except?

Decreased ferritin. **Explanation:** Anemia of Chronic Disease (ACD), also known as Anemia of Inflammation, is driven by the cytokine-mediated increase in **Hepcidin**. Hepcidin inhibits ferroportin, preventing iron release from macrophages and decreasing intestinal iron absorption. **Why Option B is the correct answer (The "Except"):** In ACD, iron is "trapped" within the reticuloendothelial system (macrophages). Since **Ferritin** is an acute-phase reactant and reflects stored iron, its levels are **increased or normal**, never decreased. A decreased ferritin is the hallmark of Iron Deficiency Anemia (IDA), not ACD [1]. **Analysis of Incorrect Options:** * **A. Decreased serum iron:** True. Since iron is sequestered in macrophages and not released into the plasma, circulating serum iron levels fall [1]. * **C. Decreased TIBC:** True. Total Iron Binding Capacity (TIBC) is a measure of transferrin. In inflammatory states, the liver decreases transferrin production. This helps differentiate ACD (Low TIBC) from IDA (High TIBC) [1]. * **D. Increased bone marrow iron:** True. Prussion blue staining of a bone marrow aspirate in ACD shows abundant iron within macrophages, confirming that the body has iron but cannot utilize it for erythropoiesis. **NEET-PG High-Yield Pearls:** * **Key Mediator:** Interleukin-6 (IL-6) stimulates the liver to produce **Hepcidin**. * **Morphology:** Usually Normocytic Normochromic, but can become Microcytic Hypochromic in long-standing cases [1]. * **The "Gold Standard" Differentiator:** * **ACD:** High Ferritin, Low TIBC, High Marrow Iron. * **IDA:** Low Ferritin, High TIBC, Absent Marrow Iron [1]. * **Transferrin Saturation:** Decreased in both ACD and IDA.

Q: All of the following are true about anticoagulants except?

Sodium diphosphate helps in the synthesis of ATP. This question tests the knowledge of blood preservation and the specific roles of additives in anticoagulant solutions. ### **Explanation of the Correct Option** **Option C is the incorrect statement (and thus the correct answer).** In blood preservation solutions like CPD (Citrate Phosphate Dextrose), **Sodium Acid Phosphate (NaH₂PO₄)** is added primarily as a **buffer** to maintain the pH of the stored blood. It prevents the excessive drop in pH caused by the accumulation of lactic acid (a byproduct of glycolysis). While ATP is vital for red cell survival, its synthesis is primarily supported by **Dextrose** (which provides the energy source) and **Adenine** (which provides the substrate for ATP synthesis). ### **Analysis of Other Options** * **Option A (CPDA-1):** Citrate Phosphate Dextrose Adenine-1 allows for a storage life of **35 days**. The addition of Adenine to the standard CPD solution improves ATP regeneration, extending the shelf life from 21 to 35 days. * **Option B (SAGM):** Saline-Adenine-Glucose-Mannitol is an additive solution used after removing plasma. It provides optimal nutrients and membrane stabilization (via Mannitol), extending the shelf life to **42 days**. * **Option D (Citrate):** Citrate (Sodium Citrate) is the primary anticoagulant in all standard blood bags. It works by **chelating (binding) ionized calcium**, which is Factor IV in the coagulation cascade, thereby preventing clot formation. ### **High-Yield Clinical Pearls for NEET-PG** * **Citrate:** Anticoagulant (Calcium chelator). * **Dextrose:** Energy source for glycolysis. * **Phosphate:** Buffer (maintains pH). * **Adenine:** Maintains high ATP levels (extends life to 35 days). * **2,3-DPG:** Levels decrease during storage, leading to an increased affinity of hemoglobin for oxygen (Left shift of the Oxygen Dissociation Curve). * **Storage Temperature:** Whole blood/PRBCs must be stored at **2–6°C**.

Q: A child died soon after birth. On examination, there was hepatosplenomegaly and edema all over the body. What is the most probable diagnosis?

Alpha Thalassemia. ### Explanation The clinical presentation of a neonate with generalized edema (anasarca) and hepatosplenomegaly who dies shortly after birth is classic for **Hydrops Fetalis**. **Why Alpha Thalassemia is Correct:** The most severe form of Alpha Thalassemia is **Hb Bart’s (α-thalassemia major)**, where all four alpha-globin genes are deleted (--/--). Since alpha chains are essential for the formation of both fetal hemoglobin (HbF, α2γ2) and adult hemoglobin (HbA, α2β2), their absence leads to the formation of gamma-chain tetramers (γ4), known as **Hb Bart’s**. * **Pathophysiology:** Hb Bart’s has an extremely high affinity for oxygen and does not release it to tissues, leading to severe intrauterine hypoxia, high-output cardiac failure, massive hepatosplenomegaly (due to extramedullary hematopoiesis), and ultimately, **Hydrops Fetalis**. **Why the Other Options are Incorrect:** * **Beta Thalassemia:** Symptoms do not appear at birth because newborns primarily have HbF (α2γ2). Beta-chain production only becomes significant around 6 months of age, which is when Beta Thalassemia Major typically manifests. * **Hereditary Spherocytosis:** While it can cause neonatal jaundice or anemia, it rarely causes hydrops fetalis or immediate neonatal death. * **Sickle Cell Anemia:** Similar to Beta Thalassemia, symptoms are delayed until HbF levels drop and beta-S chains increase (usually after 6 months). **High-Yield Clinical Pearls for NEET-PG:** * **Hb Bart’s:** γ4 tetramers (Alpha-thalassemia major, 4 gene deletion). * **HbH Disease:** β4 tetramers (3 gene deletion). * **Most common cause of non-immune hydrops** in Southeast Asia is Alpha Thalassemia. * **Diagnosis:** Confirmed by Hemoglobin electrophoresis showing Hb Bart’s.

Q: Which of the following statements about coagulation factor VII is not true?

Deficiency is associated with prolonged APTT. Factor VII (Proconvertin) is a vitamin K-dependent protease that plays a pivotal role in the Extrinsic Pathway of the coagulation cascade. 1. Why Option A is the Correct Answer (The False Statement): The Activated Partial Thromboplastin Time (APTT) measures the integrity of the Intrinsic and Common pathways (Factors XII, XI, IX, VIII, X, V, II, and I). Since Factor VII is uniquely part of the Extrinsic Pathway, its deficiency will result in a prolonged Prothrombin Time (PT) but a normal APTT [1]. Therefore, the statement that deficiency is associated with prolonged APTT is incorrect. 2. Analysis of Other Options: * Option B: Fresh Frozen Plasma (FFP) contains all coagulation factors, including Factor VII. It is a standard treatment for factor deficiencies when specific concentrates are unavailable. * Option C: Congenital Factor VII deficiency (Hypoconvertinemia) is a rare bleeding disorder inherited in an Autosomal Recessive pattern [2]. * Option D: Factor VII has the shortest half-life (approximately 4–6 hours) of all clotting factors. In contrast, Factor XII (Hageman factor) has a much longer half-life (approximately 48–52 hours). Clinical Pearls for NEET-PG: * Isolated PT prolongation with a normal APTT is the hallmark of Factor VII deficiency or early Vitamin K deficiency/Warfarin therapy (as Factor VII levels drop first) [1]. * Factor VII is the first factor to decrease in liver disease due to its short half-life, making PT a sensitive marker for acute liver protein synthesis. * Treatment: Recombinant activated Factor VII (rFVIIa) is the preferred treatment for severe bleeding or surgery in these patients.

Q: What is the characteristic translocation seen in mantle cell lymphoma?

t(11;14). **Explanation:** **Mantle Cell Lymphoma (MCL)** is a B-cell neoplasm characterized by the chromosomal translocation **t(11;14)(q13;q32)**. This translocation involves the fusion of the **CCND1 gene** (on chromosome 11) with the **IgH (Immunoglobulin Heavy chain) promoter** (on chromosome 14). This leads to the constitutive overexpression of **Cyclin D1**, a protein that promotes the transition of cells from the G1 to the S phase of the cell cycle, driving uncontrolled cellular proliferation. **Analysis of Incorrect Options:** * **A. t(8;14):** This is the hallmark of **Burkett Lymphoma**. It involves the translocation of the *c-MYC* proto-oncogene to the IgH locus, leading to rapid cell growth (starry-sky appearance). * **C. t(11;18):** This is associated with **MALT lymphoma** (Mucosa-Associated Lymphoid Tissue). It involves the fusion of *API2* and *MALT1* genes. * **D. t(9;22):** Known as the **Philadelphia Chromosome**, this is characteristic of **Chronic Myeloid Leukemia (CML)** and some cases of ALL. It creates the *BCR-ABL1* fusion protein with tyrosine kinase activity. **High-Yield Clinical Pearls for NEET-PG:** * **Immunophenotype:** MCL cells are typically **CD5+**, **CD20+**, and **Cyclin D1 positive**, but notably **CD23 negative** (helps differentiate it from CLL/SLL). * **Morphology:** Look for a "mantle" of small-to-medium-sized lymphocytes surrounding a germinal center [1]. * **Clinical Presentation:** Often presents in elderly males with lymphadenopathy and frequent involvement of the gastrointestinal tract (appearing as **lymphomatous polyposis**) [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 562-563.

Question 1

All of the following cause intravascular hemolysis, except?

Accepted Answer

Thalassemia

Answer

Mismatched blood transfusion

Answer

Snake bite

Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Question 2

What is the normal ratio of Kappa to Lambda free light chains in serum?

Accepted Answer

4:6

Answer

7:3

Answer

6:4

Answer

3:7

Question 3

All are true about anemia of chronic disease, except?

Accepted Answer

Decreased ferritin

Answer

Decreased serum iron

Answer

Decreased TIBC

Answer

Increased bone marrow iron

Question 4

What is true regarding prothrombin time measurement?

Accepted Answer

Should be measured within 2 hours

Answer

Platelet-rich plasma is required

Answer

Activated with kaolin

Answer

Immediate refrigeration is necessary to preserve coagulation factor viability

Question 5

Which of the following is NOT a feature of intravascular hemolysis?

Accepted Answer

Thrombocytopenia

Answer

Hemosiderinuria

Answer

Decreased haptoglobin

Answer

Raised indirect bilirubin

Question 6

All of the following are true about anticoagulants except?

Accepted Answer

Sodium diphosphate helps in the synthesis of ATP

Answer

Maximum storage with CPDA-1 is 35 days

Answer

Maximum storage with SAGM is 42 days

Answer

Citrate prevents coagulation by chelating calcium

Question 7

A child died soon after birth. On examination, there was hepatosplenomegaly and edema all over the body. What is the most probable diagnosis?

Accepted Answer

Alpha Thalassemia

Answer

Beta Thalassemia

Answer

Hereditary spherocytosis

Answer

Sickle cell anemia

Question 8

Which of the following CD markers is NOT used for diagnostic criteria for systemic mastocytosis?

Accepted Answer

CD 20

Answer

CD 2

Answer

CD 25

Answer

CD 117

Question 9

Which of the following statements about coagulation factor VII is not true?

Accepted Answer

Deficiency is associated with prolonged APTT

Answer

Deficiency can be managed by Fresh Frozen Plasma

Answer

Deficiency is inherited as an Autosomal Recessive trait

Answer

Has a short half-life in comparison to Hageman factor (XII)

Question 10

What is the characteristic translocation seen in mantle cell lymphoma?

Accepted Answer

t(11;14)

Answer

t(8;14)

Answer

t(11;18)

Answer

t(9;22)

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?