Hematopathology Practice Questions

Q: Aplastic anemia is known to potentially progress to which of the following conditions?

All of the above. **Explanation:** Aplastic Anemia (AA) is a bone marrow failure syndrome characterized by pancytopenia and a hypocellular marrow. While it is primarily a failure of stem cell production, it is closely linked to several **clonal myeloid disorders** due to the intense selective pressure on the remaining hematopoietic stem cell pool [1]. **Why "All of the above" is correct:** 1. **Paroxysmal Nocturnal Hemoglobinuria (PNH):** This is the most common clonal evolution. Approximately 40–50% of AA patients harbor a small population of PIGA-mutant (GPI-anchor deficient) cells. This occurs because these "PNH clones" may escape the autoimmune T-cell attack that destroys normal stem cells in AA [1]. 2. **Myelodysplastic Syndrome (MDS) & Acute Myeloid Leukemia (AML):** Long-term survivors of AA (especially those treated with immunosuppressive therapy) have a 10–15% risk of developing secondary MDS or AML. This is often associated with acquired cytogenetic abnormalities, most commonly **Monosomy 7** or Trisomy 8. **Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow aspiration and biopsy showing <25% cellularity (replaced by fat cells). * **PNH-AA Syndrome:** Always screen AA patients for PNH clones using **Flow Cytometry** (CD55/CD59 deficiency) [1]. * **Fanconi Anemia:** In pediatric cases, always rule out this autosomal recessive condition, which carries a much higher risk of progression to AML and squamous cell carcinomas. * **Treatment of Choice:** Allogeneic Stem Cell Transplant (SCT) for young patients; Immunosuppressive Therapy (Antithymocyte Globulin + Cyclosporine) for older patients [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 662.

Question 1

Target cells are seen in peripheral blood in which of the following conditions?

Accepted Answer

Thalassemia

Answer

Pernicious anemia

Answer

Aplastic anemia

Answer

Sickle cell anemia

Question 2

In Fanconi anemia, what is the underlying cause?

Accepted Answer

Mutation of a DNA repair gene

Answer

Deficiency of copper

Answer

No increased risk of squamous cell carcinoma

Answer

Purely nutritional disorder etiology

Question 3

What type of RBC is seen in chronic renal failure?

Accepted Answer

Normocytic

Answer

Microcytic

Answer

Macrocytic

Answer

None

Question 4

Which of the following conditions does NOT prolong the Prothrombin Time (PT)?

Accepted Answer

Immune Thrombocytopenic Purpura (ITP)

Answer

Christmas Disease (Factor IX deficiency)

Answer

Hemophilia A (Factor VIII deficiency)

Answer

Hemophilia B (Factor IX deficiency)

Question 5

Sezary-Lutzner cells are characterized by all of the following except?

Accepted Answer

Malignant CD 4 T-cells

Answer

Hyperconvoluted cerebriform nucleus

Answer

Hallmark of mycosis fungoides

Answer

Mostly affects the older population over 40 years

Question 6

A lymph node from a 10-year-old boy reveals large pleomorphic lymphocytes with CD30 positivity, frequent mitoses, and scattered cells bearing kidney-shaped nuclei. Which of the following statements is true?

Accepted Answer

Hallmark cells are a feature.

Answer

t(2;5) translocation imparts a worsened prognosis.

Answer

ALK protein immunostaining is seen in a minority of cases.

Answer

This tumor occurs exclusively in children.

Question 7

Aplastic anemia is known to potentially progress to which of the following conditions?

Accepted Answer

All of the above

Answer

Acute Myeloid Leukemia (AML)

Answer

Myelodysplastic syndrome

Answer

Paroxysmal nocturnal hemoglobinuria

Question 8

Eosin-5-malatide binding is characteristic of which condition?

Accepted Answer

Hereditary spherocytosis

Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Non-Hodgkin Lymphoma

Answer

Thalassemia

Question 9

Gingiva are enlarged in leukemia because of which of the following?

Accepted Answer

WBC infiltration

Answer

Capillary dilation

Answer

Erythrocyte engorgement

Answer

Edema

Question 10

An adult patient presents with generalized lymphadenopathy and blood film shows 70% immature looking lymphocytes. What is the next best investigation?

Accepted Answer

Immunophenotyping

Answer

Genotyping/karyotyping

Answer

Bone marrow examination

Answer

Peripheral smear study

Hematopathology — MCQs

Hematopathology — MCQs

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