Hematopathology Practice Questions

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: Poor prognosis in Acute Myeloid Leukemia (AML) is indicated by which of the following?

Monosomy 7. **Explanation:** In Acute Myeloid Leukemia (AML), cytogenetics is the most significant independent prognostic factor for determining clinical outcome and treatment strategy. [1] **Why Monosomy 7 is the Correct Answer:** Monosomy 7 (-7) and Deletion 7q (7q-) are classified under the **adverse/poor risk category**. These chromosomal abnormalities are often associated with complex karyotypes, prior exposure to alkylating agents (therapy-related AML), or evolution from Myelodysplastic Syndrome (MDS). Patients with Monosomy 7 typically show poor response to standard induction chemotherapy and have high relapse rates, often requiring hematopoietic stem cell transplantation (HSCT). **Analysis of Incorrect Options:** * **Inversion 16 [inv(16)]:** This is a hallmark of AML-M4eo (with abnormal eosinophils). It is categorized as a **favorable prognosis** marker with high rates of complete remission. [1] * **Translocation 15;17 [t(15;17)]:** This defines Acute Promyelocytic Leukemia (APL/M3). It carries a **favorable prognosis** due to its high sensitivity to All-trans Retinoic Acid (ATRA) and Arsenic Trioxide. [1] * **Normal Cytogenetics:** This is classified as **Intermediate-risk**. While not as favorable as inv(16), it carries a significantly better prognosis than Monosomy 7. **High-Yield Clinical Pearls for NEET-PG:** * **Favorable Prognosis:** t(8;21), t(15;17), inv(16), and NPM1 mutation (without FLT3-ITD). [1] * **Poor Prognosis:** Monosomy 7, Monosomy 5, del(5q), t(6;9), 11q23 (MLL gene) rearrangements, and **FLT3-ITD** mutations. [1] * **Most common cytogenetic abnormality in AML:** Normal karyotype (~40-50% of cases). * **Auer Rods:** Most commonly seen in t(15;17) and t(8;21). [1] **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, p. 620.

Q: Apheresis is defined as:

Selective separation of components of blood. **Explanation:** **Apheresis** (derived from the Greek word *aphaeresis*, meaning "to take away") is a medical technology in which the blood of a donor or patient is passed through an apparatus that **selectively separates one or more specific components** (such as plasma, platelets, or leukocytes) and returns the remainder to the circulation. * **Why Option A is correct:** The core principle of apheresis is the selective removal of a specific blood constituent based on density or size using centrifugation or membrane filtration. It allows for the collection of large volumes of a single component from a single donor (e.g., Single Donor Platelets). * **Why Option B is incorrect:** While apheresis products are "leukoreduced" (reducing CMV transmission or febrile reactions), the primary definition is the separation process, not infection prevention. * **Why Option C is incorrect:** This describes *Plateletpheresis*, which is merely one specific subtype of apheresis. The term apheresis itself is broader and encompasses the separation of any component (RBCs, WBCs, or Plasma). * **Why Option D is incorrect:** This refers to microbiological techniques (e.g., subculturing), which is unrelated to hematological blood processing. **High-Yield Clinical Pearls for NEET-PG:** 1. **Plasmapheresis:** Used therapeutically in conditions like **Guillain-Barré Syndrome**, **Myasthenia Gravis**, and **TTP** (to remove autoantibodies or toxins). 2. **Leukapheresis:** Indicated in cases of extreme hyperleukocytosis (e.g., AML/CML with leukostasis). 3. **Erythrocytapheresis:** Used in severe Sickle Cell Disease to exchange HbS for HbA. 4. **Anticoagulation:** **Citrate** is the most common anticoagulant used during the apheresis procedure; watch for signs of hypocalcemia in the donor.

Question 1

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 2

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 3

Hematopoietic stem cells differ from progenitor stem cells in that they can:

Accepted Answer

Have a role in bone marrow regeneration

Answer

Form terminally differentiated cells

Answer

Produce growth factors

Answer

Have receptors for anchoring proteins

Question 4

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 5

Poor prognosis in Acute Myeloid Leukemia (AML) is indicated by which of the following?

Accepted Answer

Monosomy 7

Answer

Inversion 16

Answer

Translocation 15;17 (t15;17)

Answer

Normal cytogenetics

Question 6

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 7

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 8

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 9

Apheresis is defined as:

Accepted Answer

Selective separation of components of blood

Answer

Preventing blood transfusion infections

Answer

Separation of platelets from plasma

Answer

Isolating organisms from mixed culture

Question 10

All of the following cause intravascular hemolysis, except?

Accepted Answer

Thalassemia

Answer

Mismatched blood transfusion

Answer

Snake bite

Answer

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Hematopathology — MCQs

Hematopathology — MCQs

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