Hematopathology Practice Questions

Q: Macrocytosis is seen in all of the following disorders, except?

Thalassemia major. **Explanation:** The correct answer is **Thalassemia major** because it is a disorder characterized by **microcytic hypochromic anemia**, not macrocytosis. [1] **1. Why Thalassemia Major is the correct answer:** In Thalassemia, there is a genetic defect in the synthesis of globin chains (alpha or beta). This leads to deficient hemoglobin production. To compensate for the lack of hemoglobin, the red blood cell undergoes extra divisions in the bone marrow, resulting in smaller cells (**Microcytosis**, MCV < 80 fL). [1] **2. Why the other options are incorrect (Causes of Macrocytosis):** * **Vitamin B12 and Folic Acid Deficiency:** These are the classic causes of **Megaloblastic Anemia**. Both are essential for DNA synthesis (specifically thymidine production). Deficiency leads to "nuclear-cytoplasmic asynchrony," where the nucleus matures slowly while the cytoplasm grows normally, resulting in large, oval red cells (**Macro-ovalocytes**, MCV > 100 fL). * **Hypothyroidism:** This is a common cause of **Non-megaloblastic macrocytosis**. The exact mechanism is multifactorial, involving altered lipid metabolism in the RBC membrane and a direct effect of thyroid hormone deficiency on erythropoiesis. **High-Yield NEET-PG Pearls:** * **MCV Ranges:** Microcytic ( 100 fL). * **Megaloblastic vs. Non-megaloblastic:** Megaloblastic macrocytosis features **hypersegmented neutrophils** (5+ lobes), whereas non-megaloblastic (Alcoholism, Liver disease, Hypothyroidism) does not. * **Thalassemia Hallmark:** Look for **Target cells** and a Mentzer Index (MCV/RBC count) **< 13**, which helps differentiate it from Iron Deficiency Anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591, 600-601.

Q: Blood when stored at 4°C can be kept for how long?

21 days. **Explanation:** The storage life (shelf life) of whole blood is primarily determined by the **anticoagulant-preservative solution** used in the blood bag. The standard duration for blood stored at **4°C (± 2°C)** using **CPD (Citrate Phosphate Dextrose)** or **CPDA-1 (Citrate Phosphate Dextrose Adenine)** is based on the viability of Red Blood Cells (RBCs). 1. **Why 21 days is correct:** When blood is collected in **CPD**, the shelf life is **21 days**. The citrate prevents clotting by chelating calcium, while dextrose provides a substrate for glycolysis to maintain ATP levels. For a unit to be considered viable, at least **70% of the transfused RBCs must survive in the recipient's circulation for 24 hours** post-transfusion. 2. **Why other options are incorrect:** * **7 and 14 days:** These durations are too short. While metabolic changes (the "storage lesion") begin immediately, the cells remain clinically viable for much longer. * **28 days:** This is an intermediate value. While newer additive solutions extend life beyond 21 days, 28 is not the standard cutoff for CPD. **High-Yield Clinical Pearls for NEET-PG:** * **CPDA-1:** If Adenine is added (CPDA-1), the shelf life extends to **35 days** because adenine enhances ATP synthesis. * **SAGM (Saline-Adenine-Glucose-Mannitol):** If additive solutions are used after removing plasma, the shelf life extends to **42 days**. * **Storage Lesion:** During storage at 4°C, certain changes occur: **↓ pH, ↓ 2,3-DPG (shifting the O2 dissociation curve to the left), ↓ Sodium, and ↑ Potassium.** * **Temperature:** Blood must be stored at **2°C to 6°C**. Platelets, conversely, are stored at **20°C to 24°C** with constant agitation for only 5 days.

Question 1

Which of the following conditions is associated with Coombs-positive hemolysis?

Accepted Answer

Systemic lupus erythematosus (SLE)

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Immune thrombocytopenic purpura (ITP)

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Question 2

NESTROFT test is used for screening of:

Accepted Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Answer

Paroxysmal cold hemoglobinuria (PCH)

Question 3

Which subtype of Hodgkin lymphoma is negative for CD15 and CD30 markers?

Accepted Answer

Lymphocyte predominance

Answer

Nodular sclerosis

Answer

Mixed cellularity

Answer

Lymphocyte depletion

Question 4

What is the cause of severe hemorrhage in Acute Promyelocytic Leukemia?

Accepted Answer

Disseminated intravascular coagulation

Answer

Immune complex deposits on blood vessels

Answer

Thrombocytopenia

Answer

Thrombocytosis

Question 5

Macrocytosis is seen in all of the following disorders, except?

Accepted Answer

Thalassemia major

Answer

Hypothyroidism

Answer

Folic acid deficiency

Answer

Vitamin B12 deficiency

Question 6

All of the following features are true regarding multiple myeloma except?

Accepted Answer

Dystrophic calcification

Answer

Proteinuria

Answer

Bleeding tendency

Answer

Visual disturbances

Question 7

A man living in southern Japan contracts HTLV-1 infection through sexual contact. Twenty-five years later he develops generalized lymphadenopathy with hepatosplenomegaly, a skin rash, hypercalcemia, and an elevated white blood count. This man has most likely developed which of the following?

Accepted Answer

Leukemia

Answer

AIDS

Answer

Autoimmunity

Answer

Delayed hypersensitivity reaction

Question 8

Which of the following statements regarding Hodgkin's lymphoma is incorrect?

Accepted Answer

The central nervous system is the commonest site of involvement.

Answer

The characteristic cell is a Reed Sternberg cell.

Answer

Mediastinal involvement is common in nodular sclerosis type.

Answer

Eosinophils, plasma cells, and neutrophils increase.

Question 9

Blood when stored at 4°C can be kept for how long?

Accepted Answer

21 days

Answer

7 days

Answer

14 days

Answer

28 days

Question 10

Platelet function is assessed by which of the following methods?

Accepted Answer

All of the above

Answer

Platelet adhesion

Answer

Bleeding Time (BT)

Answer

PFA-100

Hematopathology — MCQs

Hematopathology — MCQs

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