Hematopathology Practice Questions

Q: A patient presents with microcytic hypochromic anemia. Serum iron levels and TIBC are decreased. What is the likely diagnosis?

Anemia of chronic disease. ### Explanation The key to solving this question lies in the **Iron Profile**. While microcytic hypochromic anemia is common to all four options, the combination of **decreased Serum Iron** and **decreased Total Iron Binding Capacity (TIBC)** is classic for **Anemia of Chronic Disease (ACD)**. [1] #### 1. Why Anemia of Chronic Disease is Correct In ACD, chronic inflammation leads to an increase in **Hepcidin** (an acute-phase reactant). [1] Hepcidin inhibits **ferroportin**, trapping iron inside macrophages and hepatocytes. [2] * **Serum Iron decreases** because iron cannot be released into the blood. [2] * **TIBC (Transferrin) decreases** because the body downregulates transferrin production in response to inflammation (unlike IDA, where it increases to "search" for iron). * **Ferritin** is typically normal or increased (reflecting trapped storage iron). [3] #### 2. Why Other Options are Incorrect * **Iron Deficiency Anemia (IDA):** While serum iron is low, **TIBC is increased** as the body compensates by producing more transferrin to maximize transport. [1] Ferritin is always low in IDA. * **Thalassemia:** This is a defect in globin chain synthesis. Iron studies are typically **normal or show iron overload** (increased Ferritin/Serum Iron) due to ineffective erythropoiesis. * **Sideroblastic Anemia:** Characterized by a defect in heme synthesis. It typically presents with **increased Serum Iron** and high Ferritin due to iron loading in the mitochondria (ringed sideroblasts). #### 3. High-Yield NEET-PG Pearls * **Gold Standard for ACD:** Bone marrow biopsy showing increased iron in macrophages (Prussian blue stain) but absent iron in erythroid precursors. [3] * **Hepcidin:** The "Master Regulator" of iron metabolism. [2] * **Differentiation Rule:** * Low Iron + High TIBC = **IDA** * Low Iron + Low TIBC = **ACD** * **Mentzer Index (MCV/RBC count):** 13 suggests IDA.

Question 1

Which is the most common red blood cell defect without hemoglobin abnormality?

Accepted Answer

Spherocytosis

Answer

Elliptocytosis

Answer

Poikilocytosis

Answer

Sickle cell disease

Question 2

Which of the following conditions is associated with the maximum Erythrocyte Sedimentation Rate (ESR)?

Accepted Answer

Multiple myeloma

Answer

Congestive Heart Failure (CHF)

Answer

Polycythemia vera

Answer

Sickle cell anemia

Question 3

Kaolin cephalin clotting time (KCT) is a test primarily used to assess which part of the coagulation cascade?

Accepted Answer

The intrinsic pathway

Answer

The extrinsic pathway

Answer

Common pathway

Answer

Platelet function

Question 4

The t(8;14) translocation is associated with the activation of which of the following genes?

Accepted Answer

c-myc

Answer

c-abl

Answer

bcl-2

Answer

bcl-I

Question 5

Prolonged prothrombin time is seen in which of the following conditions?

Accepted Answer

Factor VII deficiency

Answer

Haemophilia A

Answer

Haemophilia B

Answer

Thrombocytopenia

Question 6

Regarding G6PD deficiency, which of the following is true?

Accepted Answer

Bite cells are positive.

Answer

It is an autosomal dominant disorder.

Answer

It protects against kala azar.

Answer

The enzyme level is directly proportional to the age of RBC.

Question 7

ALL L3 cells resemble which of the following?

Accepted Answer

Burkitt's lymphoma

Answer

Mantle cell lymphoma

Answer

Hodgkin's lymphoma

Answer

Follicular lymphoma

Question 8

What is a common complication seen in polycythemia vera?

Accepted Answer

Myelofibrosis

Answer

Infection

Answer

Hemolysis

Answer

Renal failure

Question 9

Which of the following is the binding site for the von Willebrand factor multimers on the platelets?

Accepted Answer

Glycoprotein 1b

Answer

ADP

Answer

Factor VIII

Answer

Thromboxane A2

Question 10

A patient presents with microcytic hypochromic anemia. Serum iron levels and TIBC are decreased. What is the likely diagnosis?

Accepted Answer

Anemia of chronic disease

Answer

Iron deficiency anemia

Answer

Thalassemia

Answer

Sideroblastic anemia

Hematopathology — MCQs

Hematopathology — MCQs

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