Hematopathology Practice Questions

Q: The presence of Heinz bodies in erythrocytes indicates which of the following?

Oxidative stress. **Explanation:** Heinz bodies are inclusions within red blood cells (RBCs) composed of **denatured, precipitated hemoglobin**. The primary mechanism behind their formation is **oxidative stress**. When RBCs are exposed to oxidative damage (often due to drugs like dapsone, fava beans, or infections), the sulfhydryl groups on the globin chains are oxidized, causing the hemoglobin to lose its solubility and precipitate [1]. This is most commonly seen in **G6PD deficiency**, where the lack of NADPH prevents the regeneration of reduced glutathione, leaving the cell vulnerable to oxidative injury [1]. **Analysis of Options:** * **Option A (Malarial infection):** Malaria is characterized by intracellular parasites (ring forms, gametocytes) or Schüffner’s dots, not precipitated hemoglobin. * **Option B (Hemoglobin abnormalities):** While certain unstable hemoglobins (e.g., Hb Cologne) can cause Heinz bodies, "Oxidative stress" is the more fundamental physiological process that triggers the precipitation. * **Option D (Degraded bacterial forms):** Bacteria do not form intra-erythrocytic inclusions like Heinz bodies. **NEET-PG High-Yield Pearls:** 1. **Staining:** Heinz bodies are **not visible on routine Leishman or Wright-Giemsa stains**. they require **Supravital stains** (e.g., Crystal Violet, Brilliant Cresyl Blue, or Methylene Blue). 2. **Bite Cells (Degmacytes):** When RBCs containing Heinz bodies pass through the splenic sinusoids, splenic macrophages pluck out the inclusions, resulting in "Bite cells" seen on peripheral smears [1]. 3. **Differential:** Do not confuse Heinz bodies with **Howell-Jolly bodies** (DNA remnants seen in hyposplenism) or **Pappenheimer bodies** (iron granules seen in sideroblastic anemia). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 642-643.

Q: Which of the following does NOT cause sideroblastic anemia?

Mercury poisoning. **Explanation:** Sideroblastic anemia is characterized by the presence of **ringed sideroblasts** in the bone marrow, which are erythroblasts with iron-laden mitochondria encircling the nucleus. This occurs due to a failure to incorporate iron into protoporphyrin to form heme. **Why Mercury Poisoning is the Correct Answer:** While several heavy metals interfere with heme synthesis [1], **Lead poisoning** is the classic cause of sideroblastic anemia. **Mercury poisoning**, conversely, typically presents with neurological symptoms (tremors, erethism), renal failure, or acrodynia [2], but it does **not** characteristically cause sideroblastic anemia. **Analysis of Incorrect Options:** * **Isoniazid (INH):** This is a classic cause. INH is a Vitamin B6 (Pyridoxine) antagonist. Since Pyridoxine is a required cofactor for **ALAS (delta-aminolevulinic acid synthase)**, the rate-limiting enzyme in heme synthesis [1], its deficiency leads to sideroblastic changes. * **Chloramphenicol:** This antibiotic inhibits mitochondrial protein synthesis, interfering with the mitochondrial enzymes necessary for heme production. * **Myelodysplastic Syndrome (MDS):** Specifically, the subtype **RARS (Refractory Anemia with Ringed Sideroblasts)** is a common primary/acquired cause of sideroblastic anemia in the elderly due to mitochondrial DNA mutations. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow examination with **Prussian Blue stain** showing $\geq 5$ siderotic granules covering $\geq 1/3$ of the nuclear circumference. * **Reversible Causes:** Alcohol (most common), Lead, INH, and Copper deficiency. * **Treatment:** For INH-induced cases, administer **Pyridoxine (B6)**. * **Blood Smear:** Look for **dimorphic anemia** (two populations of RBCs: microcytic and normocytic) and **Pappenheimer bodies**.

Q: Fresh Frozen Plasma (FFP) is stored at what temperature?

Below -25 degrees Celsius. ### Explanation **Correct Option: C (Below -25 degrees Celsius)** Fresh Frozen Plasma (FFP) is the liquid portion of whole blood that is separated and frozen within 8 hours of collection [1]. The primary goal of FFP storage is to preserve **labile coagulation factors**, specifically **Factor V and Factor VIII**. According to standard guidelines (including WHO and DGHS India), FFP must be stored at temperatures **below -25°C** to maintain a shelf life of up to **1 year**. If stored between -18°C and -25°C, the shelf life is reduced to 3 months [1]. **Analysis of Incorrect Options:** * **A & D (2-4°C and 2-10°C):** These are the storage temperature ranges for **Packed Red Blood Cells (PRBCs)** and Whole Blood [1]. At these temperatures, labile clotting factors in plasma degrade rapidly, rendering it ineffective for treating coagulopathies. * **B (0 to -25°C):** While FFP can be stored at -18°C, the standard "ideal" storage for maximum factor preservation and the specific threshold tested in competitive exams is "below -25°C." **High-Yield Clinical Pearls for NEET-PG:** * **Thawing:** FFP must be thawed at **30-37°C** in a water bath before use. Once thawed, it must be transfused within **24 hours** (stored at 2-6°C) to ensure factor activity. * **Indications:** Multiple coagulation factor deficiencies (e.g., Liver disease, DIC), Warfarin reversal, and TTP (Plasmapheresis). * **Dosage:** The standard dose is **10-15 mL/kg**. * **Cryoprecipitate:** Formed by thawing FFP at 4°C; it is rich in **Factor VIII, Fibrinogen, von Willebrand Factor, and Factor XIII**.

Question 1

Which staining technique is used to detect coarse basophilic stippling?

Accepted Answer

Coarse basophilic stippling

Answer

Peripheral blood reticulocytes

Answer

Heinz bodies

Answer

Globin chain inclusions in severe thalassemia

Question 2

The presence of Heinz bodies in erythrocytes indicates which of the following?

Accepted Answer

Oxidative stress

Answer

Malarial infection

Answer

Hemoglobin abnormalities

Answer

Degraded bacterial forms

Question 3

What is the most common type of heavy chain disease?

Accepted Answer

Alpha chain disease

Answer

Gamma chain disease

Answer

Mu chain disease

Answer

Delta chain disease

Question 4

In which of the following conditions does the Periodic Acid-Schiff (PAS) test show block positivity?

Accepted Answer

Acute lymphoblastic leukemia (ALL)

Answer

Acute myeloid leukemia (AML)

Answer

Chronic myeloid leukemia (CML)

Answer

Hodgkin's lymphoma

Question 5

What is the most common type of Hodgkin's lymphoma?

Accepted Answer

Nodular sclerosis

Answer

Lymphocyte predominant

Answer

Lymphocyte depletion

Answer

Mixed cellularity

Question 6

All of the following are B cell markers except?

Accepted Answer

CD 34

Answer

CD 22

Answer

CD 19

Answer

CD 20

Question 7

Which of the following does NOT cause sideroblastic anemia?

Accepted Answer

Mercury poisoning

Answer

Isoniazid (INH)

Answer

Chloramphenicol

Answer

Myelodysplastic syndrome

Question 8

Bleeding in Disseminated Intravascular Coagulation (DIC) is most closely related to which of the following?

Accepted Answer

Low serum fibrinogen level

Answer

Raised fibrin degradation products level in blood

Answer

Prolonged prothrombin time

Answer

Raised thrombin time

Question 9

Fresh Frozen Plasma (FFP) is stored at what temperature?

Accepted Answer

Below -25 degrees Celsius

Answer

2-4 degrees Celsius

Answer

0 to -25 degrees Celsius

Answer

2-10 degrees Celsius

Question 10

Which of the following conditions is characterized by CD5+ lymphocytes?

Accepted Answer

Mantle cell lymphoma

Answer

Hairy cell leukemia

Answer

Burkitt lymphoma

Answer

Follicular cell lymphoma

Hematopathology — MCQs

Hematopathology — MCQs

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