Hematopathology Practice Questions

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.

Q: All are features of hemolytic anemia except?

Thrombocytopenia. Explanation: Hemolytic anemia is characterized by the premature destruction of red blood cells (RBCs) [1]. The hallmarks of this condition are related to the release of intracellular contents and the body’s compensatory response to anemia. Why Thrombocytopenia is the correct answer: Thrombocytopenia (low platelet count) is **not** a standard feature of hemolytic anemia. In most hemolytic processes, the pathology is specific to the erythrocyte lineage. While certain conditions like Evans Syndrome (AIHA + ITP) or Microangiopathic Hemolytic Anemias (TTP/HUS) involve both low RBCs and platelets, they are specific syndromes rather than general features of hemolysis [2]. Why the other options are incorrect: * **Decreased Haptoglobin:** Haptoglobin is a transport protein that binds to free hemoglobin. In intravascular hemolysis, haptoglobin is rapidly consumed as it clears hemoglobin, making it a highly sensitive marker for hemolysis. * **Raised Indirect Bilirubin:** When RBCs break down, heme is converted into unconjugated (indirect) bilirubin. The liver's conjugating capacity is overwhelmed, leading to unconjugated hyperbilirubinemia and clinical jaundice. * **Hemosiderinuria:** In chronic intravascular hemolysis, filtered hemoglobin is reabsorbed by renal tubular cells. When these cells slough off into the urine, they contain iron deposits (hemosiderin), which can be detected by Prussian blue staining. NEET-PG High-Yield Pearls: * **Best initial test for hemolysis:** Peripheral smear (look for schistocytes or spherocytes) and Reticulocyte count (will be elevated). * **Most specific marker for intravascular hemolysis:** Low serum Haptoglobin. * **Intravascular vs. Extravascular:** Hemoglobinuria and Hemosiderinuria are features of **intravascular** hemolysis only. Splenomegaly is more common in **extravascular** hemolysis [1]. * **LDH:** Serum Lactate Dehydrogenase is typically elevated due to release from ruptured RBCs.

Question 1

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 2

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 3

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 4

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 5

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

Question 6

All of the following are associated with Secondary Hemochromatosis except?

Accepted Answer

Paroxysmal Nocturnal Haemoglobinuria (PNH)

Answer

Thalassemia Major

Answer

Sideroblastic Anemia

Answer

Hereditary Spherocytosis

Question 7

Which of the following is not a finding in classical hemophilia (hemophilia A)?

Accepted Answer

Increased Prothrombin Time

Answer

Bleeding into soft tissues, muscles, and joints

Answer

Decreased factor VIII

Answer

Increased Partial Thromboplastin Time

Question 8

All are features of hemolytic anemia except?

Accepted Answer

Thrombocytopenia

Answer

Hemosiderinuria

Answer

Decreased haptoglobin

Answer

Raised indirect bilirubin

Question 9

Bence Jones proteins are:

Accepted Answer

Light chains of IgG

Answer

Heavy chains of IgG

Answer

Present in bone marrow

Answer

Seen in lymphoma

Question 10

Which of the following is NOT a feature of chronic leukemia?

Accepted Answer

Leukocytosis with circulating blasts and cytopenias are common

Answer

Often diagnosed incidentally

Answer

Splenomegaly is common

Answer

Lymphadenopathy is common

Hematopathology — MCQs

Hematopathology — MCQs

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