Hematopathology Practice Questions

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.

Q: Which of the following bleeding disorders are associated with an increased aPTT?

Hemophilia A, Hemophilia B, Von-Willebrand disease. Explanation: The **Activated Partial Thromboplastin Time (aPTT)** measures the integrity of the **intrinsic** and **common pathways** of the coagulation cascade [1]. Any deficiency or inhibition of factors XII, XI, IX, VIII, X, V, II (prothrombin), or I (fibrinogen) will result in a prolonged aPTT. * **Hemophilia A & B:** These are X-linked recessive disorders caused by deficiencies in **Factor VIII** and **Factor IX**, respectively [2]. Since both factors are vital components of the intrinsic pathway, their deficiency leads to a characteristically increased aPTT with a normal PT and bleeding time. * **Von-Willebrand Disease (vWD):** vWF acts as a carrier protein for Factor VIII, protecting it from degradation [3]. In vWD, low levels of vWF lead to a secondary decrease in Factor VIII levels, thereby prolonging the aPTT [3]. Additionally, vWD presents with an increased bleeding time due to defective platelet adhesion. **Analysis of Incorrect Options:** * **Henoch-Schönlein Purpura (HSP):** This is a small-vessel vasculitis (IgA-mediated). It is a vascular disorder where coagulation profiles (PT, aPTT) and platelet counts remain **normal**. * **Bernard-Soulier Syndrome:** This is a qualitative platelet disorder (deficiency of GpIb). While it increases the **bleeding time**, the coagulation cascade (aPTT/PT) is unaffected. **High-Yield Clinical Pearls for NEET-PG:** * **Isolated prolonged aPTT:** Think Hemophilia, vWD, or Heparin use [1]. * **Isolated prolonged PT:** Think Factor VII deficiency or early Warfarin therapy. * **Prolonged PT and aPTT:** Think Vitamin K deficiency, Liver disease, or DIC [1]. * **Mixing Study:** If aPTT corrects with normal plasma, it indicates a **factor deficiency**; if it fails to correct, an **inhibitor** (like Lupus anticoagulant) is present [1].

Q: Which of the following is true about anemia of chronic disease?

Normal or increased serum ferritin. Anemia of Chronic Disease (ACD), also known as anemia of inflammation, is the second most common cause of anemia worldwide. It occurs due to the body’s inflammatory response to chronic infections, malignancies, or autoimmune disorders. **Why Option C is Correct:** The pathophysiology of ACD is driven by **Hepcidin**, an acute-phase reactant produced by the liver in response to IL-6. Hepcidin degrades ferroportin (the iron export channel), leading to: 1. **Sequestration of iron** within macrophages and hepatocytes. 2. **Decreased intestinal iron absorption.** Because iron is trapped inside storage cells, **Serum Ferritin** (the storage form of iron) remains **normal or increased**. This distinguishes ACD from Iron Deficiency Anemia (IDA), where ferritin is always low. **Why Other Options are Incorrect:** * **A. Increased TIBC:** In ACD, Total Iron Binding Capacity (TIBC) is **decreased**. The body downregulates transferrin production to limit iron availability to potential pathogens. * **B. Normal serum iron levels:** Serum iron is **decreased** in ACD because iron is "locked away" in macrophages and not available in the circulation. * **D. Increased transferrin saturation:** Since serum iron is low, the **transferrin saturation is decreased** (typically 10-20%). **NEET-PG High-Yield Pearls:** * **Hallmark:** Low serum iron + Low TIBC + Normal/High Ferritin. * **Key Mediator:** Hepcidin (inhibits ferroportin). * **Morphology:** Usually normocytic normochromic, but can become microcytic hypochromic in long-standing cases. * **Treatment:** Treat the underlying inflammatory condition; erythropoietin may be used in specific cases (e.g., CKD).

Q: A 34-year-old man presents with symptoms of fatigue, weakness, nose bleeds, and palpitations with exertion. On examination, he is pale, blood pressure is 110/70 mm Hg, pulse is 100/min, heart sounds are normal, lungs are clear, and he has multiple petechiae and bruises on his legs. His blood count is abnormal: hemoglobin 8.5 g/dL, white blood cells (WBCs) 4000/mL, platelets 50,000/mL, and there are blast cells in the peripheral blood. He is diagnosed with acute promyelocytic leukemia (AML-M3). Which of the following is a characteristic of this acute myelogenous leukemia?

Auer bodies in blast cells. The patient presents with symptoms of pancytopenia (fatigue, bleeding, pallor) and peripheral blasts, characteristic of Acute Myeloid Leukemia (AML). Specifically, the diagnosis of **Acute Promyelocytic Leukemia (APL/AML-M3)** is established [1]. **1. Why the correct answer is right:** **Auer bodies** are elongated, needle-like pink/red cytoplasmic inclusions formed by the fusion of primary granules (lysosomes) containing peroxidase. They are a hallmark of myeloblasts. In AML-M3, these are not only present but often found in clusters called **"Faggot cells."** Their presence confirms a myeloid lineage and is highly characteristic of the hypergranular promyelocytes seen in M3. **2. Why the incorrect options are wrong:** * **A. Peak incidence in childhood:** This describes **Acute Lymphoblastic Leukemia (ALL)**. AML typically affects middle-aged and older adults (median age ~65), though APL (M3) often presents in younger adults (median age ~40). * **B. High leukocyte alkaline phosphatase (LAP):** A high LAP score is seen in **Leukemoid reactions** or polycythemia vera. In contrast, Chronic Myeloid Leukemia (CML) is characterized by a *low* LAP score. * **C. Philadelphia chromosome:** This refers to the **t(9;22)** translocation, which is the diagnostic hallmark of **CML** and a poor prognostic marker in ALL [1]. AML-M3 is associated with **t(15;17)** [1]. **High-Yield NEET-PG Pearls for AML-M3:** * **Molecular Pathogenesis:** Translocation **t(15;17)** involving the **PML-RARA** gene fusion [1]. * **Clinical Emergency:** High risk of **DIC (Disseminated Intravascular Coagulation)** due to the release of procoagulants from granules. * **Treatment:** Targeted therapy with **ATRA (All-Trans Retinoic Acid)** and Arsenic Trioxide, which induces differentiation of promyelocytes. * **Morphology:** Bilobed nuclei and numerous Auer bodies (Faggot cells).

Q: Which of the following is NOT a characteristic feature of Macrophage Activation Syndrome?

Low levels of plasma ferritin. **Explanation:** **Macrophage Activation Syndrome (MAS)** is a life-threatening complication of systemic inflammatory disorders, most commonly **Systemic Juvenile Idiopathic Arthritis (sJIA)**. It is considered a form of secondary Hemophagocytic Lymphohistiocytosis (HLH). **Why Option B is the correct answer:** In MAS, there is an extreme elevation of **plasma ferritin** (often >10,000 ng/mL). Ferritin is not just a storage protein here; it is an acute-phase reactant secreted by activated macrophages. Therefore, **low levels of plasma ferritin** are never seen in MAS; hyperferritinemia is a hallmark diagnostic criterion. **Analysis of Incorrect Options:** * **Option A:** MAS is driven by the uncontrolled proliferation and **activation of CD8+ T cells** and macrophages. These cells infiltrate organs, leading to tissue damage. * **Option C:** The pathophysiology involves a massive **cytokine storm**, specifically involving high levels of Pro-inflammatory cytokines like **IL-1, IL-6, IL-18, and IFN-gamma**, which leads to multi-organ failure. * **Option D:** MAS is clinically and pathologically indistinguishable from **secondary HLH**. While HLH is often used for genetic/familial forms, MAS is the term specifically used when it occurs in the context of autoimmune/rheumatologic diseases. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Persistent high fever, hepatosplenomegaly, and cytopenias. * **Laboratory Hallmarks:** High Ferritin, **High Triglycerides**, and **Low Fibrinogen** (due to consumption). * **Paradoxical Finding:** A sudden **drop in ESR** (due to low fibrinogen) in a previously inflamed patient is a strong red flag for MAS. * **Treatment:** High-dose corticosteroids (Methylprednisolone) and Cyclosporine; IL-1 inhibitors (Anakinra) are also effective.

Question 1

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 2

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

Question 3

A 38-year-old male presents with increasing weakness and a markedly elevated peripheral leukocyte count. Laboratory testing on peripheral blood finds a decreased leukocyte alkaline phosphatase (LAP) score, and chromosomal studies on a bone marrow aspirate find the presence of a Philadelphia chromosome. This abnormality refers to a characteristic chromosomal translocation that involves which oncogene?

Accepted Answer

c-abl

Answer

bcl-2 erb-B

Answer

c-myc

Answer

erb-B

Question 4

Which of the following bleeding disorders are associated with an increased aPTT?

Accepted Answer

Hemophilia A, Hemophilia B, Von-Willebrand disease

Answer

Hemophilia B, Henoch-Schonlein purpura, Bernard-Soulier syndrome

Answer

Henoch-Schonlein purpura, Bernard-Soulier syndrome, Von-Willebrand disease

Answer

Hemophilia A, Henoch-Schonlein purpura, Von-Willebrand disease

Question 5

Which laboratory test differentiates leukemoid reaction from chronic myeloid leukemia?

Accepted Answer

Leukocyte alkaline phosphatase (LAP)

Answer

Leukocyte common antigen (LCA)

Answer

Myelo-peroxidase (MPO)

Answer

Tartrate resistant alkaline phosphatase (TRAP)

Question 6

Which of the following is true about anemia of chronic disease?

Accepted Answer

Normal or increased serum ferritin

Answer

Increased TIBC

Answer

Normal serum iron levels

Answer

Increased transferrin saturation

Question 7

Laboratory evaluation for the differential diagnosis of chronic myeloproliferative disorders includes all of the following except?

Accepted Answer

Flow-cytometric analysis

Answer

Chromosomal evaluation

Answer

Bone marrow aspiration

Answer

Determination of red blood cell mass

Question 8

A 34-year-old man presents with symptoms of fatigue, weakness, nose bleeds, and palpitations with exertion. On examination, he is pale, blood pressure is 110/70 mm Hg, pulse is 100/min, heart sounds are normal, lungs are clear, and he has multiple petechiae and bruises on his legs. His blood count is abnormal: hemoglobin 8.5 g/dL, white blood cells (WBCs) 4000/mL, platelets 50,000/mL, and there are blast cells in the peripheral blood. He is diagnosed with acute promyelocytic leukemia (AML-M3). Which of the following is a characteristic of this acute myelogenous leukemia?

Accepted Answer

Auer bodies in blast cells

Answer

Peak incidence in childhood

Answer

High leukocyte alkaline phosphatase

Answer

Philadelphia chromosome

Question 9

Which of the following is NOT a characteristic feature of Macrophage Activation Syndrome?

Accepted Answer

Low levels of plasma ferritin

Answer

Activation of CD8+ T cells

Answer

Presence of a cytokine storm

Answer

It is an alternative name for hemophagocytic lymphohistiocytosis

Question 10

Which one of the listed types of antibodies is the best example of a cold agglutinin associated with cold autoimmune hemolytic anemia?

Accepted Answer

An anti-I IgM antibody associated with infectious mononucleosis

Answer

An anti-AB IgM antibody associated with isoimmune blood transfusion reaction

Answer

An anti-I IgG antibody associated with rheumatoid arthritis

Answer

An anti-P IgG antibody associated with paroxysmal cold hemoglobinuria

Hematopathology — MCQs

Hematopathology — MCQs

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