Hematopathology Practice Questions

Q: What is the chromosomal abnormality seen in promyelocytic leukemia?

t(15;17). **Explanation:** **Acute Promyelocytic Leukemia (APL)**, classified as AML-M3 in the FAB system, is characterized by the pathognomonic balanced reciprocal translocation **t(15;17)(q22;q12)** [1]. 1. **Mechanism of Correct Answer (A):** This translocation involves the fusion of the **PML** (Promyelocytic Leukemia) gene on chromosome 15 and the **RARα** (Retinoic Acid Receptor alpha) gene on chromosome 17 [1]. The resulting **PML-RARα fusion protein** acts as a dominant-negative repressor, blocking myeloid differentiation at the promyelocyte stage [2]. High doses of All-Trans Retinoic Acid (ATRA) can overcome this block, inducing the maturation of leukemic cells [2]. 2. **Analysis of Incorrect Options:** * **t(9;21):** This is not a standard recognized translocation in common leukemias. (Note: t(8;21) is associated with AML-M2). * **t(9;22):** Known as the **Philadelphia chromosome**, this is the hallmark of **Chronic Myeloid Leukemia (CML)** and is also seen in a subset of B-ALL (poor prognosis). It involves the BCR-ABL1 fusion. 3. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** Presence of **Auer rods** (often in bundles called **Faggot cells**) [1]. * **Complication:** High risk of **Disseminated Intravascular Coagulation (DIC)** due to the release of procoagulants from primary granules. * **Treatment:** ATRA and Arsenic Trioxide (ATO) [2]. * **Cytogenetics:** Essential for diagnosis; FISH or RT-PCR can detect the PML-RARα transcript. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 620-621. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Neoplasia, p. 326.

Q: What is characteristically found in the bone marrow in lead poisoning?

Ringed siderocytes. **Explanation:** Lead poisoning (Plumbism) interferes with the biosynthesis of heme by inhibiting two key enzymes: **delta-aminolevulinic acid dehydratase (ALAD)** and **Ferrochelatase** [1]. The inhibition of Ferrochelatase prevents the incorporation of iron into the protoporphyrin ring. Consequently, iron accumulates within the mitochondria of developing erythroblasts in the bone marrow. When these cells are stained with **Prussian Blue (Perls' stain)**, the iron-laden mitochondria appear as a necklace-like ring around the nucleus, termed **Ringed Sideroblasts** (or Siderocytes in mature forms). **Analysis of Options:** * **A. Ringed siderocytes (Correct):** These are the hallmark of sideroblastic anemias, which can be hereditary or acquired (e.g., lead poisoning, alcohol, or MDS). * **B. Giant metamyelocytes:** These are characteristic of **Megaloblastic Anemia** (Vitamin B12 or Folate deficiency) due to impaired DNA synthesis and nuclear-cytoplasmic dyssynchrony. * **C. Dwarf megakaryocytes (Micromegakaryocytes):** These are small, mononuclear megakaryocytes typically seen in **Myelodysplastic Syndromes (MDS)** or Chronic Myeloid Leukemia (CML). * **D. Fibrotic changes:** Extensive marrow fibrosis is characteristic of **Primary Myelofibrosis** or late-stage "spent phase" polycythemia vera. **High-Yield Clinical Pearls for NEET-PG:** * **Peripheral Smear:** Look for **Coarse Basophilic Stippling** (due to inhibition of 5'-nucleotidase, leading to ribosomal RNA degradation). * **X-ray:** "Lead lines" at the metaphyses of growing long bones in children [1]. * **Gums:** "Burtonian lines" (bluish-purple pigmentation at the gingival margin). * **Treatment:** Chelation therapy with **Succimer** (oral, first-line in kids) or **CaNa₂EDTA**. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-419.

Question 1

Marginal zone lymphoma is a type of:

Accepted Answer

B cell lymphoma

Answer

T cell lymphoma

Answer

NK cell lymphoma

Answer

Hodgkin lymphoma

Question 2

What is the chromosomal abnormality seen in promyelocytic leukemia?

Accepted Answer

t(15;17)

Answer

t(9;21)

Answer

t(9;22)

Answer

None of the above

Question 3

All are features of typical B cell Chronic Lymphocytic Leukemia (CLL), EXCEPT:

Accepted Answer

Abnormalities involving chromosome 11

Answer

Increased monoclonal B cells expressing the CD5 antigen

Answer

The peripheral blood smear shows smudge cells

Answer

Trisomy 12 is found in 25-30% of cases

Question 4

Following blood transfusion, non-cardiogenic pulmonary edema may sometimes occur because of?

Accepted Answer

Antigen-antibody mechanism involving human leukocyte antigen

Answer

RBC incompatibility

Answer

Platelet surface antigen reaction

Answer

Antibody to IgA in donor plasma

Question 5

Which of the following is NOT included in chronic myeloproliferative disorders?

Accepted Answer

Erythroleukemia

Answer

Polycythemia vera

Answer

Chronic myeloid leukemia (CML)

Answer

Essential thrombocytosis

Question 6

Absolute lymphocytosis is typically seen in which of the following conditions?

Accepted Answer

Infectious Mononucleosis (IMN)

Answer

Systemic Lupus Erythematosus (SLE)

Answer

Typhoid fever

Answer

Brucellosis

Question 7

A 35,000/mm
3

hematocrit; prothrombin time-20 sec with a control of 13 sec; partial thromboplastin time-50sec; and Fibrinogen 10mg/dL. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely diagnosis?

Accepted Answer

Acute myeloblastic leukemia without maturation

Answer

Acute myeloblastic leukemia with maturation

Answer

Acute promyelocytic leukemia

Answer

Acute myelomonocytic leukemia

Question 8

What is the most accurate statement regarding Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

DIC is associated with increased levels of D-dimer.

Answer

Removal of the underlying cause leads to complete resolution.

Answer

It is associated with increased serum fibrinogen levels.

Answer

Normal clotting parameters excludes DIC.

Question 9

What is characteristically found in the bone marrow in lead poisoning?

Accepted Answer

Ringed siderocytes

Answer

Giant metamyelocytes

Answer

Dwarf megakaryocytes

Answer

Fibrotic changes

Question 10

Which mediastinal tumor is most likely associated with red blood cell aplasia?

Accepted Answer

Thymoma

Answer

Hodgkin's disease

Answer

Neuroblastoma

Answer

Parathyroid adenoma

Hematopathology — MCQs

Hematopathology — MCQs

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