Hematopathology Practice Questions

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

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 2

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

Accepted Answer

M3

Answer

M2

Answer

M4

Answer

M5

Question 3

"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 4

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 5

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

Question 6

What is the most common virus implicated in lymphoproliferative cancer in a child post-kidney transplant?

Accepted Answer

Epstein-Barr virus (EBV)

Answer

Cytomegalovirus (CMV)

Answer

Varicella-zoster virus

Answer

Human papillomavirus (HPV)

Question 7

Acid phosphatase is specific to which of the following cells?

Accepted Answer

Monocyte

Answer

T lymphocyte

Answer

B lymphocyte

Answer

Myelocytes

Question 8

All the following diseases contain abnormal immunoglobulin except:

Accepted Answer

Reactive arthritis

Answer

Multiple myeloma

Answer

Seligman's disease

Answer

Franklin's disease

Question 9

Which anticoagulant is best suited for the osmotic fragility test?

Accepted Answer

Heparin

Answer

EDTA

Answer

Trisodium citrate

Answer

Potassium oxalate

Question 10

Which of the following is used to irradiate blood products?

Accepted Answer

Gamma rays

Answer

Alpha rays

Answer

Beta rays

Answer

X-rays

Hematopathology — MCQs

Hematopathology — MCQs

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