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.

Q: A 45-year-old male presents with bony pain, with no history of trauma or drug abuse. Investigations revealed an ESR of 140 mm/hr and Hb of 6 gm/dL. A peripheral smear is shown below. What type of chromosomal abnormality is associated with a favorable prognosis in this patient?

t(11;14). ***t(11;14)*** - This translocation involves **CCND1 gene** overexpression and is associated with **standard/favorable risk** in multiple myeloma prognostic stratification. - Patients with t(11;14) typically have **better overall survival** and **response to treatment** compared to other high-risk translocations. *t(14;16)* - This translocation involves the **MAF oncogene** and is classified as **high-risk** by International Myeloma Working Group (IMWG) criteria. - Associated with **poor prognosis**, **aggressive disease course**, and **shorter overall survival** in multiple myeloma patients. *t(4;14)* - This translocation results in **FGFR3** and **MMSET gene** dysregulation and is considered **high-risk** cytogenetics. - Patients typically have **poor prognosis** with **reduced progression-free survival** and **overall survival** rates. *Loss of 13q14* - This chromosomal deletion is associated with **intermediate to poor prognosis** when present as monosomy 13 or del(13q). - Often occurs in conjunction with other **high-risk cytogenetic abnormalities** and contributes to **adverse outcomes** in multiple myeloma.

Q: Microcytosis is seen in which of the following conditions?

All of the above. ### Explanation **Concept:** Microcytosis (Mean Corpuscular Volume < 80 fL) occurs when there is a defect in hemoglobin synthesis [2]. This is typically due to a deficiency in iron (Iron Deficiency Anemia), a defect in heme synthesis (Sideroblastic Anemia), or a defect in globin chain production (Thalassemia and Hemoglobinopathies) [3]. **Analysis of Options:** * **A. Thalassemia:** This is the classic cause of microcytosis. It involves a quantitative reduction in the synthesis of alpha or beta-globin chains, leading to hypochromic microcytic RBCs [1]. * **B. Hb Lepore:** This is a variant hemoglobin formed by the fusion of delta and beta-globin genes (δβ-fusion). Clinically, it behaves like **Beta-Thalassemia trait or major**, resulting in ineffective erythropoiesis and significant microcytosis. * **C. Hb Bart’s:** This occurs in Alpha-Thalassemia when three or four alpha genes are deleted. In the absence of alpha chains, gamma chains form tetramers ($\gamma_4$). These tetramers have an extremely high affinity for oxygen and do not deliver it to tissues, leading to severe microcytosis and potentially *Hydrops Fetalis* [3]. **Conclusion:** Since all three conditions involve defective or abnormal globin chain production leading to smaller red blood cells, **Option D (All of the above)** is correct. **High-Yield Clinical Pearls for NEET-PG:** * **Mentzer Index:** MCV/RBC count. A ratio ** 13** suggests Iron Deficiency Anemia. * **RDW (Red Cell Distribution Width):** Usually normal in Thalassemia trait but elevated in Iron Deficiency Anemia. * **HbH Disease:** A form of Alpha-Thalassemia (3-gene deletion) characterized by $\beta_4$ tetramers and "golf-ball" appearance of RBCs on supra-vital staining [3].

Q: Which blood product has the maximum shelf life?

Fresh Frozen Plasma (FFP). The shelf life of blood products is determined by the metabolic requirements of the cells, the preservative used, and the storage temperature. ### **Explanation of the Correct Answer** **Fresh Frozen Plasma (FFP)** has the maximum shelf life because it is stored in a frozen state at temperatures of **-18°C or colder**. At these temperatures, the degradation of coagulation factors is significantly slowed, allowing FFP to be stored for up to **1 year**. If stored at -65°C, the shelf life can extend up to 7 years. ### **Analysis of Incorrect Options** * **Whole Blood:** Typically stored at 2-6°C. Its shelf life depends on the anticoagulant-preservative solution used: **35 days** with CPDA-1 and 21 days with CPD/ACD. * **Packed Red Blood Cells (PRBC):** Similar to whole blood, PRBCs are stored at 2-6°C. With additive solutions like SAGM (Saline-Adenine-Glucose-Mannitol), the shelf life is extended to **42 days**. * **Platelet Concentrate:** Platelets have the shortest shelf life (**5 days**) because they must be stored at room temperature (20-24°C) with continuous agitation to maintain viability and prevent aggregation. Storage is limited due to the high risk of bacterial growth at these temperatures. ### **High-Yield Facts for NEET-PG** * **Cryoprecipitate:** Like FFP, it is stored at -18°C and has a shelf life of **1 year**. * **Irradiated RBCs:** Shelf life is reduced to **28 days** from the date of irradiation. * **Frozen RBCs:** Can be stored for up to **10 years** in glycerol at -65°C (rarely used, but technically the longest). * **Thawed FFP:** Once thawed, it must be used within **24 hours** if stored at 1-6°C.

Question 1

What is a common complication seen in polycythemia vera?

Accepted Answer

Myelofibrosis

Answer

Infection

Answer

Hemolysis

Answer

Renal failure

Question 2

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 3

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

Question 4

A 45-year-old male presents with bony pain, with no history of trauma or drug abuse. Investigations revealed an ESR of 140 mm/hr and Hb of 6 gm/dL. A peripheral smear is shown below. What type of chromosomal abnormality is associated with a favorable prognosis in this patient?

Accepted Answer

t(11;14)

Answer

t(14;16)

Answer

t(4;14)

Answer

Loss of 13q14

Question 5

Which of the following disorders has the potential to develop myeloid leukemia?

Accepted Answer

Paroxysmal nocturnal Hemoglobinuria

Answer

Microangiopathic hemolytic anemia

Answer

Sideroblastic anemia

Answer

Megaloblastic anemia

Question 6

Lymphoma is caused by all of the following viruses except?

Accepted Answer

HSV

Answer

HIV

Answer

EBV

Answer

HHV8

Question 7

Microcytosis is seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Thalassemia

Answer

Hb Lepore

Answer

Hb Bart's

Question 8

Which of the following is NOT a characteristic feature of non-Hodgkin lymphoma?

Accepted Answer

Arises in a single node or chain of nodes

Answer

Non-contiguous spread in an unpredictable fashion

Answer

Mesenteric nodes and Waldeyer's ring are involved

Answer

Extranodal involvement

Question 9

An anemic patient has the following red cell indexes: mean corpuscular volume, 70 mm
3
; mean corpuscular hemoglobin, 22 pg; and mean corpuscular hemoglobin concentration, 34%. These values are most consistent with which diagnosis?

Accepted Answer

Thalassemia minor

Answer

Folic acid-deficiency anemia

Answer

Iron-deficiency anemia

Answer

Pernicious anemia

Question 10

Which blood product has the maximum shelf life?

Accepted Answer

Fresh Frozen Plasma (FFP)

Answer

Whole blood

Answer

Packed Red Blood Cells (PRBC)

Answer

Platelet concentrate

Hematopathology — MCQs

Hematopathology — MCQs

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