Hematopathology Practice Questions

Q: Which of the following conditions is involved when there is excessive bleeding after labor, and laboratory studies demonstrate decreased platelets, prolonged prothrombin time and partial thromboplastin time, and increased fibrin split products?

Disseminated intravascular coagulation. **Explanation:** The clinical presentation of excessive postpartum bleeding combined with the specific laboratory profile—**thrombocytopenia** (decreased platelets), **prolonged PT and PTT**, and **elevated fibrin split products (FSPs/D-dimers)**—is pathognomonic for **Disseminated Intravascular Coagulation (DIC)**. **Why DIC is correct:** DIC is a consumptive coagulopathy. In obstetrics, it is often triggered by the release of tissue factor into the maternal circulation (e.g., in placental abruption, amniotic fluid embolism, or retained dead fetus). This leads to widespread activation of the coagulation cascade, forming microthrombi that consume platelets and clotting factors (prolonging PT/PTT). Simultaneously, the fibrinolytic system is activated to break down these clots, resulting in elevated FSPs and D-dimers. **Why other options are incorrect:** * **Hemophilia A:** An X-linked recessive deficiency of Factor VIII. It typically presents with an isolated prolonged PTT; platelet count, PT, and FSPs remain normal. * **Severe Liver Disease:** While it can cause decreased clotting factors and prolonged PT/PTT, it rarely causes the acute, massive elevation of FSPs seen in the context of labor-related hemorrhage. * **Vitamin K Deficiency:** Leads to deficiency of Factors II, VII, IX, and X. This prolongs PT (and PTT in severe cases) but does not cause thrombocytopenia or elevated FSPs. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of DIC in pregnancy:** Placental Abruption. * **Earliest lab indicator of DIC:** Decreased Fibrinogen levels (often <150 mg/dL in pregnancy is critical). * **Management:** Treat the underlying cause (e.g., deliver the fetus/placenta) and replace blood products (FFP, Cryoprecipitate, and Platelets).

Q: In acute myeloid leukemia, Auer rods are numerous in which subtype?

M3. **Explanation:** Auer rods are needle-like, azurophilic cytoplasmic inclusions formed by the fusion of primary granules (lysosomes) containing peroxidase. They are pathognomonic for **Acute Myeloid Leukemia (AML)**. **Why M3 is the correct answer:** In the FAB classification, **AML-M3 (Acute Promyelocytic Leukemia)** is characterized by a proliferation of abnormal promyelocytes. These cells contain an abundance of primary granules, leading to the formation of **numerous Auer rods** [1]. A classic finding in M3 is the presence of **"Faggot cells,"** which are blasts containing bundles or clusters of multiple Auer rods [1]. This subtype is associated with the **t(15;17)** translocation and carries a high risk of Disseminated Intravascular Coagulation (DIC) due to the release of procoagulant material from these granules [1]. **Analysis of incorrect options:** * **M2 (AML with maturation):** Auer rods are frequently present but are usually solitary or few in number, not "numerous" as seen in M3 [1]. * **M4 (Acute Myelomonocytic Leukemia):** Blasts show both myeloid and monocytic differentiation. Auer rods may be present in the myeloid component but are not a hallmark feature [1]. * **M5 (Acute Monocytic Leukemia):** Auer rods are typically **absent** in pure monocytic leukemias (M5a/M5b) [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Auer Rods Composition:** Crystalline aggregates of **Myeloperoxidase (MPO)**. * **M3 Treatment:** All-trans retinoic acid (ATRA) and Arsenic trioxide. * **M4eo Subtype:** Associated with **inv(16)** and characterized by abnormal eosinophils with large basophilic granules [1]. * **M5 Association:** Often presents with **gum hypertrophy** and skin involvement (leukemia cutis). **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. 620-622.

Q: Pelger-Huët anomaly is characterized by the presence of which of the following in neutrophils?

Hyposegmented neutrophils. **Explanation:** **Pelger-Huët Anomaly (PHA)** is an autosomal dominant inherited condition characterized by a failure of normal nuclear segmentation in neutrophils. This occurs due to a mutation in the **Lamin B receptor (LBR) gene**, which is essential for maintaining the nuclear envelope's structure. 1. **Why Option A is correct:** In PHA, the neutrophil nuclei are **hyposegmented**. They typically present with only two lobes connected by a thin filament of chromatin, giving them a characteristic **"pince-nez" appearance** (like a pair of spectacles). Despite the abnormal shape, the chromatin is mature and coarse, and the cells function normally. 2. **Why Option B is incorrect:** **Hypersegmented neutrophils** (defined as >5% of neutrophils having 5 lobes or any having ≥6 lobes) are the hallmark of **Megaloblastic anemia** (Vitamin B12 or Folate deficiency) [1]. 3. **Why Option C is incorrect:** While some neutrophils in PHA may appear unsegmented (round or oval nuclei), the defining diagnostic feature is the consistent pattern of hyposegmentation across the majority of the granulocyte population. **High-Yield Clinical Pearls for NEET-PG:** * **Pseudo-Pelger-Huët Anomaly:** This is an *acquired* form of hyposegmentation seen in **Myelodysplastic Syndromes (MDS)**, Acute Myeloid Leukemia (AML), or certain drug therapies (e.g., Tacrolimus). * **Differentiation:** In the inherited form, nearly 100% of neutrophils are affected. In the acquired (pseudo) form, only a fraction of cells are affected, and they often show "hypogranularity." * **Key Morphological Clue:** Look for the **"Pince-nez"** description in clinical vignettes to identify PHA. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 654.

Question 1

A child died soon after birth. On examination, there was hepatosplenomegaly and edema all over the body. What is the most probable diagnosis?

Accepted Answer

alpha-thalassemia

Answer

beta-thalassemia

Answer

Hereditary spherocytosis

Answer

ABO incompatibility/sickle cell anemia

Question 2

Which of the following statements about paroxysmal cold hemoglobinuria is NOT true?

Accepted Answer

Chronic autoimmune form responds well to splenectomy

Answer

Results from formation of Donath-Landsteiner antibody

Answer

Attacks are associated with hemoglobinuria

Answer

Can occur secondary to syphilis

Question 3

Which of the following conditions is involved when there is excessive bleeding after labor, and laboratory studies demonstrate decreased platelets, prolonged prothrombin time and partial thromboplastin time, and increased fibrin split products?

Accepted Answer

Disseminated intravascular coagulation

Answer

Hemophilia A

Answer

Severe liver disease

Answer

Vitamin K deficiency

Question 4

All of the following are true about neutrophils in peripheral smear examination, EXCEPT:

Accepted Answer

If neutrophil granules are smaller and stain red, they are called toxic granules.

Answer

Vacuolated neutrophils may be a sign of bacterial sepsis.

Answer

The presence of neutrophils with more than five nuclear lobes suggests megaloblastic anemia.

Answer

Large, misshapen granules may reflect the inherited Chediak-Higashi syndrome.

Question 5

A 42-year-old man presents with a 2-week history of fever, weakness, and bleeding gums. Peripheral smear shows pancytopenia. Bone marrow examination revealed 26% blasts, frequently exhibiting Auer rods and mature myeloid cells. An occasional neutrophil with pseudo Pelger-Huet anomaly was also noted. Which of the following cytochemical stains is most likely to be positive?

Accepted Answer

Myeloperoxidase

Answer

Acid phosphatase

Answer

Nonspecific esterase

Answer

Toluidine blue

Question 6

What is the main inflammatory mediator in anemia of chronic disease?

Accepted Answer

Interleukin-6 (IL-6)

Answer

Interleukin-1 (IL-1)

Answer

Interleukin-2 (IL-2)

Answer

Interferon-gamma (IFN-γ)

Question 7

In acute myeloid leukemia, Auer rods are numerous in which subtype?

Accepted Answer

M3

Answer

M2

Answer

M4

Answer

M5

Question 8

"Chicken-wire" appearance of enlarged bone marrow spaces is seen in which of the following conditions?

Accepted Answer

Beta thalassemia major

Answer

Fetal alcohol syndrome

Answer

Sickle cell anaemia

Answer

Haemophilia A

Question 9

Lysis of RBCs are seen in all of the following except?

Accepted Answer

Obstructive jaundice

Answer

Thalassemia

Answer

Methotrexate therapy

Answer

Sickle cell anemia

Question 10

Pelger-Huët anomaly is characterized by the presence of which of the following in neutrophils?

Accepted Answer

Hyposegmented neutrophils

Answer

Hypersegmented neutrophils

Answer

Unsegmented neutrophils

Answer

None of the above

Hematopathology — MCQs

Hematopathology — MCQs

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