Hematopathology Practice Questions

Q: Which of the following is NOT a feature of hemolytic anemia?

Increased haptoglobin. ### Explanation In hemolytic anemia, the hallmark is the premature destruction of red blood cells (RBCs). This process leads to the release of free hemoglobin into the plasma [1]. **Why "Increased haptoglobin" is the correct answer:** Haptoglobin is a plasma protein produced by the liver whose primary function is to bind free hemoglobin to prevent oxidative damage and iron loss. In hemolytic states (especially intravascular hemolysis), large amounts of hemoglobin are released. Haptoglobin binds to this hemoglobin, and the resulting **haptoglobin-hemoglobin complex** is rapidly cleared by the reticuloendothelial system (liver). Consequently, serum **haptoglobin levels decrease** (often becoming undetectable), not increase. **Analysis of incorrect options:** * **A. Hemoglobinuria:** When the hemoglobin-binding capacity of haptoglobin is saturated, free hemoglobin is filtered by the renal glomeruli, appearing in the urine [1]. * **B. Jaundice:** Hemolysis leads to an increase in unconjugated bilirubin (a byproduct of heme breakdown). When this exceeds the liver's conjugating capacity, acholuric jaundice occurs. * **D. Hemosiderinuria:** This is a sign of chronic intravascular hemolysis. Iron from reabsorbed hemoglobin accumulates in renal tubular cells as hemosiderin; when these cells slough off into the urine, it is detected via Prussian blue staining [1]. **Clinical Pearls for NEET-PG:** * **Best initial test for hemolysis:** Peripheral blood smear (look for schistocytes or spherocytes) and Reticulocyte count (increased). * **Most specific biochemical marker for intravascular hemolysis:** Decreased serum haptoglobin. * **Markers of Hemolysis:** ↑ Indirect Bilirubin, ↑ LDH, ↑ Reticulocytes, ↓ Haptoglobin. * **Intravascular vs. Extravascular:** Hemoglobinuria and Hemosiderinuria are specific to **intravascular** hemolysis [1].

Q: Which of the following is a marker for Langerhans cell histiocytosis?

CD 1a. **Explanation:** **Langerhans Cell Histiocytosis (LCH)** is a clonal proliferation of Langerhans cells, which are specialized dendritic cells normally found in the skin. The diagnosis relies on identifying these cells through specific immunophenotypic markers and ultrastructural findings [1]. **Why CD1a is correct:** Langerhans cells are characterized by the expression of **CD1a** and **Langerin (CD207)**. CD1a is a glycoprotein structurally related to MHC molecules and is highly specific for Langerhans cells when found in the context of histiocytic lesions. Another gold-standard marker is **S100** (though it is less specific). **Analysis of Incorrect Options:** * **CD10:** Also known as CALLA (Common Acute Lymphoblastic Leukemia Antigen), it is a marker for pre-B cells and germinal center B-cells. It is used to diagnose **B-ALL** and Follicular Lymphoma. * **CD30:** A marker for activated T and B cells. It is the hallmark of **Hodgkin Lymphoma** (Reed-Sternberg cells) and **Anaplastic Large Cell Lymphoma (ALCL)**. * **CD56:** An adhesion molecule used as a marker for **Natural Killer (NK) cells** and certain neuroendocrine tumors. **High-Yield Clinical Pearls for NEET-PG:** * **Electron Microscopy:** The pathognomonic finding in LCH is the **Birbeck Granule**, which has a characteristic "tennis-racket" appearance [1]. * **Langerin (CD207):** This is the most specific marker for LCH as it is directly associated with the formation of Birbeck granules [1]. * **Clinical Triad (Hand-Schüller-Christian disease):** Calvarial bone defects, exophthalmos, and diabetes insipidus. * **BRAF V600E Mutation:** Seen in approximately 50% of LCH cases [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, pp. 629-630.

Q: Auto-splenectomy is associated with which of the following conditions?

Systemic lupus erythematosus. **Explanation:** **Auto-splenectomy** refers to the progressive fibrosis and atrophy of the spleen due to repeated vascular insults, eventually leading to a non-functional, shrunken organ. **Why A is correct:** While **Sickle Cell Anemia** is the most common cause of auto-splenectomy (due to repeated micro-infarctions) [1], **Systemic Lupus Erythematosus (SLE)** is a well-recognized cause in adults. In SLE, the mechanism involves vasculitis of the splenic vessels and the deposition of immune complexes, leading to infarction and subsequent atrophy. A characteristic histological finding in SLE is **"onion-skin" thickening** of the splenic penicilliary arteries due to concentric perivascular fibrosis. **Why the other options are incorrect:** * **B. Trauma:** Splenic trauma typically leads to surgical splenectomy (splenectomy due to rupture) or the formation of accessory splenic tissue (splenosis), but not the gradual physiological atrophy known as auto-splenectomy. * **C. Sarcoidosis:** This condition typically causes **splenomegaly** (enlargement) due to the infiltration of non-caseating granulomas. * **D. ITP:** In ITP, the spleen is the site of platelet destruction, but it usually remains **normal in size** or shows only mild enlargement. It does not undergo atrophy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of auto-splenectomy:** Sickle Cell Anemia (usually complete by childhood) [1]. * **Howell-Jolly bodies:** These nuclear remnants in RBCs are a hallmark of a non-functional spleen (seen after auto-splenectomy) [1]. * **Onion-skin lesion:** Pathognomonic splenic finding in SLE. * **Other causes of small spleen:** Celiac disease and Essential Thrombocythemia. **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, pp. 631-632.

Q: Which disease is transmitted by all components of blood?

Malaria. **Explanation:** **Malaria (Correct Answer):** Malaria is caused by *Plasmodium* species, which reside within red blood cells (RBCs) during the asexual stage of their life cycle [1]. However, transmission is not limited to packed RBCs. The parasites can be present in any blood component that contains even trace amounts of RBCs or contaminated plasma, including Whole Blood, Packed RBCs, Platelets, and Fresh Frozen Plasma (FFP). Because *Plasmodium* can survive at 4°C for up to 2–3 weeks, it remains viable in standard blood bank storage, making it transmissible via all components. **Incorrect Options:** * **Syphilis (*Treponema pallidum*):** The spirochete is highly sensitive to cold. It cannot survive more than 72 hours (3 days) at 4°C. Since most blood components are refrigerated, the risk of transmission is negligible in stored blood. * **Toxoplasma (*T. gondii*):** While it can be transmitted via organ transplantation or leukocyte-rich products, it is not a standard risk across all components (like FFP) as it primarily resides in nucleated cells. * **H. pylori:** This is a gastrointestinal pathogen transmitted via the fecal-oral route; it is not a blood-borne pathogen. **Clinical Pearls for NEET-PG:** * **Storage Lesion:** Malaria is the classic example of a parasite that survives refrigeration. * **Window Period:** The most common cause of post-transfusion hepatitis is Hepatitis B (due to the window period), but the most common “parasitic” post-transfusion infection is Malaria. * **TTIs (Transfusion-Transmitted Infections):** Mandatory screening in India includes HIV, HBV, HCV, Syphilis, and Malaria. * **Bacterial Contamination:** Platelets are the most likely component to cause bacterial sepsis because they are stored at room temperature (20–24°C).

Question 1

Which of the following is NOT typically seen in Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Normal Activated Partial Thromboplastin Time (APTT)

Answer

Decreased fibrinogen

Answer

Thrombocytopenia

Answer

Elevated Prothrombin Time (PT)

Question 2

Which of the following is NOT a feature of hemolytic anemia?

Accepted Answer

Increased haptoglobin

Answer

Hemoglobinuria

Answer

Jaundice

Answer

Hemosiderinuria

Question 3

Which of the following is NOT a laboratory finding in thalassemia major?

Accepted Answer

Normal ferritin level

Answer

Normal TIBC

Answer

Microcytic hypochromic anemia

Answer

High saturation percentage

Question 4

Low serum haptoglobin in hemolysis is masked by which of the following conditions?

Accepted Answer

Bile duct obstruction

Answer

Pregnancy

Answer

Liver disease

Answer

Malnutrition

Question 5

A 16-year-old girl presents with bowel obstruction. Laparotomy reveals markedly enlarged para-aortic lymph nodes. Biopsy of the lymph nodes exhibits a diffuse neoplastic infiltrate of small, round lymphocytes with a "starry sky" appearance on low power. The cytoplasm of some of the lymphocytes is vacuolated and fat stains are positive. What immunophenotypic or cytogenetic abnormality would you expect in the neoplastic cells?

Accepted Answer

t(8;14) translocation

Answer

Positive non-specific esterase stain

Answer

Positive specific esterase stain

Answer

Low leukocyte alkaline phosphatase score

Question 6

Which of the following is a marker for Langerhans cell histiocytosis?

Accepted Answer

CD 1a

Answer

CD 10

Answer

CD 30

Answer

CD 56

Question 7

Which of the following stains is used?

Accepted Answer

Brilliant cresyl blue

Answer

Methyl violet

Answer

Sudan black

Answer

Indigo carmine

Question 8

Auto-splenectomy is associated with which of the following conditions?

Accepted Answer

Systemic lupus erythematosus

Answer

Trauma

Answer

Sarcoidosis

Answer

Idiopathic thrombocytopenic purpura (ITP)

Question 9

As compared to iron deficiency anemia, which of the following is decreased in anemia of chronic disease?

Accepted Answer

Total iron-binding capacity (TIBC)

Answer

Endogenous bone marrow iron stores

Answer

Serum ferritin

Answer

Transferrin saturation

Question 10

Which disease is transmitted by all components of blood?

Accepted Answer

Malaria

Answer

Syphilis

Answer

Toxoplasma

Answer

H. pylori

Hematopathology — MCQs

Hematopathology — MCQs

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