Hematopathology Practice Questions

Q: Iron deficiency anemia is characterized by which of the following red blood cell indices?

Microcytic hypochromic. **Explanation:** Iron Deficiency Anemia (IDA) is the most common cause of nutritional anemia worldwide. The correct answer is **Microcytic hypochromic** because iron is a critical component of heme. When iron stores are depleted, hemoglobin synthesis is impaired. 1. **Why Microcytic?** To maintain a constant concentration of hemoglobin, the erythroid precursors undergo additional divisions, resulting in smaller red blood cells (Reduced Mean Corpuscular Volume, **MCV < 80 fL** [1]). 2. **Why Hypochromic?** Since there is less hemoglobin per cell, the cells appear pale with an increased central pallor (Reduced Mean Corpuscular Hemoglobin Concentration, **MCHC < 32 g/dL** [1]). **Analysis of Incorrect Options:** * **Normochromic normocytic:** Characteristic of acute blood loss, anemia of chronic disease (early stages), or hemolytic anemias [2]. * **Normocytic hyperchromic:** This pattern is rarely seen; however, Spherocytosis may show a high MCHC, but cells are not "hyperchromic" in the traditional sense [2]. * **Macrocytic hypochromic:** Macrocytic cells (MCV > 100 fL) are typical of Vitamin B12 or Folate deficiency (Megaloblastic anemia), but these are usually normochromic. **High-Yield Clinical Pearls for NEET-PG:** * **First sign of IDA:** Decreased **Serum Ferritin** (most sensitive indicator) [1]. * **Earliest hematological change:** Increase in **RDW** (Red Cell Distribution Width/Anisocytosis). * **Mentzer Index:** MCV/RBC count. If ** 13**, it suggests IDA [3]. * **Pica and Koilonychia** (spoon-shaped nails) are specific clinical signs of chronic iron deficiency.

Q: A 6-month-old infant presents with Hb of 6 gm% and features of anemia. Peripheral blood smear shows target cells. The family history is positive for similar complaints. Which of the following investigations can best diagnose this condition?

Hb electrophoresis. ### Explanation The clinical presentation of a 6-month-old infant with severe anemia (Hb 6 gm%), target cells on peripheral smear, and a positive family history strongly suggests a **Hereditary Hemoglobinopathy**, most likely **Beta-Thalassemia Major**. **1. Why Hb Electrophoresis is Correct:** Hb electrophoresis is the gold standard for diagnosing hemoglobinopathies. In Beta-Thalassemia Major, there is a partial or total absence of beta-globin chain synthesis. Electrophoresis typically reveals a significant increase in **HbF (Fetal Hemoglobin)** and variable levels of HbA2, with little to no HbA. This confirms the diagnosis by identifying the specific hemoglobin variants present. **2. Why Other Options are Incorrect:** * **ELISA:** This is an immunological technique used to detect antigens or antibodies (e.g., HIV, Hepatitis). It has no role in diagnosing structural hemoglobin defects. * **Coombs’ Test:** This is used to diagnose **Autoimmune Hemolytic Anemia (AIHA)** by detecting antibodies on the RBC surface (Direct) or in the serum (Indirect). The presence of target cells and family history points toward a genetic defect rather than an immune-mediated one. * **Osmotic Fragility:** This is the screening test for **Hereditary Spherocytosis**. In Thalassemia, osmotic fragility is actually *decreased* (cells are more resistant to lysis), but it is not a confirmatory or specific diagnostic test for the condition. **Clinical Pearls for NEET-PG:** * **Target Cells (Codocytes):** Classically seen in Thalassemia, Liver disease, Asplenia, and HbC disease. * **Age of Presentation:** Beta-Thalassemia Major typically presents at **6 months of age** because this is when the physiological switch from HbF to HbA occurs. * **Mentzer Index:** (MCV/RBC count) 13 suggests Iron Deficiency Anemia. * **NEET-PG High-Yield:** On electrophoresis, **HbA2 > 3.5%** is diagnostic for Beta-Thalassemia Trait.

Question 1

Iron deficiency anemia is characterized by which of the following red blood cell indices?

Accepted Answer

Microcytic hypochromic

Answer

Normochromic normocytic

Answer

Normocytic hyperchromic

Answer

Macrocytic hypochromic

Question 2

A patient presents with fatigue, fever, anorexia, and weight loss. What is the most likely diagnosis?

Accepted Answer

Leukemia

Answer

Scurvy

Answer

Acquired immunodeficiency syndrome

Answer

Sarcoidosis

Question 3

Non-specific esterase is present in which of the following?

Accepted Answer

Acute Myeloid Leukemia (AML)

Answer

Megakaryocytic leukemia

Answer

Lymphocytic leukemia

Answer

Erythroleukemia

Question 4

Which subtype of Hodgkin's disease is histogenetically distinct from all other subtypes?

Accepted Answer

Lymphocyte predominant

Answer

Nodular sclerosis

Answer

Mixed cellularity

Answer

Lymphocyte depleted

Question 5

Which of the following is true about Von Willebrand's disease?

Accepted Answer

Increased platelet aggregation in response to Ristocetin

Answer

Increased bleeding time

Answer

Factor VIII C levels are decreased in circulation.

Answer

APTT is increased

Question 6

A 6-month-old infant presents with Hb of 6 gm% and features of anemia. Peripheral blood smear shows target cells. The family history is positive for similar complaints. Which of the following investigations can best diagnose this condition?

Accepted Answer

Hb electrophoresis

Answer

ELISA

Answer

Coomb's Test

Answer

Osmotic fragility

Question 7

Which of the following is the most common hemoglobinopathy?

Accepted Answer

Sickle cell anemia

Answer

Thalassemia

Answer

Hemoglobin C

Answer

Spherocytosis

Question 8

A 50-year-old female patient complains of weakness and pain in her back. She has a history of recurrent infections. Laboratory investigations reveal the presence of Bence Jones proteins in her urine. This condition results from the overproduction of abnormal immunoglobulins, which are mostly of which type?

Accepted Answer

IgG

Answer

IgM

Answer

IgA

Answer

IgD

Question 9

In β-thalassemia, what is the characteristic defect regarding the beta-globin chain?

Accepted Answer

Absence of beta chains

Answer

Excess beta chain production

Answer

Absence of any globin chains

Answer

Production of normal beta chains

Question 10

A patient with sepsis has a TLC of 15,000 cells/mm³ with the following differential: Neutrophils 40%, Eosinophils 7%, Band cells 15%, Metamyelocytes 5%, and Lymphocytes 35%. What is the immature to total neutrophil ratio (I:T ratio)?

Accepted Answer

20%

Answer

23%

Answer

30%

Answer

33%

Hematopathology — MCQs

Hematopathology — MCQs

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