Hematopathology Practice Questions

Q: Blood platelets in stored blood do not remain functional after what duration?

24 hours. **Explanation:** The functionality of platelets in stored blood is highly sensitive to temperature and storage conditions. When whole blood is collected and stored under standard refrigeration (1°C to 6°C), platelets undergo a rapid loss of viability and hemostatic activity. **Why 24 hours is correct:** Platelets are metabolically active cells that require specific conditions to maintain their discoid shape and aggregative function. In refrigerated stored blood, platelets lose their ability to form a primary hemostatic plug within **24 hours**. After this period, while the cells may still be physically present, they are functionally inert. For effective platelet transfusion, "Platelet Concentrates" must be stored at room temperature (20°C–24°C) with continuous agitation to remain viable for up to 5 days. **Analysis of Incorrect Options:** * **A (12 hours):** While some degradation begins immediately, a significant portion of platelets remains functional up to the 24-hour mark. * **C & D (48 and 72 hours):** By this time, refrigerated platelets have undergone structural changes (becoming spherical) and irreversible metabolic exhaustion, making them clinically useless for stopping a bleed. **High-Yield Clinical Pearls for NEET-PG:** * **Storage Lesion:** This refers to the loss of viability and function of blood components during storage. For platelets, the "refrigeration lesion" is the primary cause of dysfunction. * **Massive Transfusion:** Patients receiving large volumes of stored blood (older than 24 hours) often develop **dilutional thrombocytopenia**, necessitating the administration of fresh frozen plasma (FFP) and separate platelet concentrates. * **Factor Stability:** While platelets fail at 24 hours, Labile Coagulation Factors (Factor V and VIII) also decrease significantly in stored blood, though at a slightly slower rate than platelet dysfunction.

Q: Which subtype of Acute Myeloid Leukemia (AML) is characterized by gum infiltration and hepatosplenomegaly?

M4 subtype. **Explanation:** The correct answer is **M4 subtype (Acute Myelomonocytic Leukemia)**. In the FAB (French-American-British) classification of AML, subtypes with a **monocytic component** (M4 and M5) are uniquely associated with **extramedullary involvement**. This occurs because monoblasts and monocytes have a high propensity to migrate out of the bone marrow and infiltrate tissues [1]. Clinical manifestations of this tissue infiltration include **gum hypertrophy (gingival hyperplasia)**, skin involvement (leukemia cutis), and organomegaly (hepatosplenomegaly). **Analysis of Options:** * **A. Acute Lymphoblastic Leukemia (ALL):** While ALL commonly presents with hepatosplenomegaly and lymphadenopathy (especially in children), it is not typically associated with gum infiltration. * **B. M3 Subtype (Acute Promyelocytic Leukemia):** Characterized by the t(15;17) translocation and a high risk of **DIC (Disseminated Intravascular Coagulation)** due to the release of procoagulants from Auer rods [1]. It does not typically cause gum infiltration. * **C. M2 Subtype (AML with Maturation):** This is the most common subtype of AML. It is often associated with the t(8;21) translocation and the presence of **chloromas** (granulocytic sarcomas), but not specifically gum hypertrophy [1]. **High-Yield Clinical Pearls for NEET-PG:** * **M4 (Myelomonocytic):** Positive for both Myeloperoxidase (MPO) and Non-Specific Esterase (NSE). * **M5 (Monocytic):** Strongest association with gum hypertrophy; predominantly NSE positive. * **M3 (APL):** Associated with **Auer rods in faggot cells** and treated with ATRA (All-Trans Retinoic Acid). * **M0/M1/M2:** Primarily MPO positive. **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, p. 620.

Q: Which one of the labeled boxes in the diagram below is most consistent with the expected findings for an individual with polycythemia rubra vera?

Box E. ***Box E*** - Shows **markedly elevated RBC/Hct**, **elevated WBC**, and **elevated platelets** with **decreased EPO** - the classic triad of polycythemia rubra vera due to **JAK2 mutation** causing autonomous bone marrow proliferation. - **Normal oxygen saturation** with **low EPO** distinguishes primary polycythemia (PRV) from secondary causes where EPO would be elevated. *Box A* - Likely represents **normal values** with balanced RBC, WBC, platelets, and appropriate EPO levels. - Does not show the **panmyelosis** (increased RBC, WBC, and platelets) characteristic of polycythemia rubra vera. *Box B* - Probably shows **secondary polycythemia** with elevated RBC/Hct but **normal WBC and platelets** with **elevated EPO**. - Lacks the **autonomous proliferation** of all cell lines seen in PRV due to **JAK2 mutation**. *Box D* - May represent **relative polycythemia** or **dehydration** with elevated Hct but normal other parameters. - Missing the **clonal myeloproliferation** affecting multiple cell lines that defines polycythemia rubra vera.

Q: What is the most suitable test to assess iron stores?

Serum ferritin. No changes were made to the explanation because none of the provided references met the relevance threshold for citation. Serum ferritin is considered the most suitable and sensitive initial test to assess total body iron stores. Ferritin is an intracellular protein that stores iron in a non-toxic form and releases it in a controlled manner. In a healthy individual, the amount of ferritin in the serum is directly proportional to the total iron stores in the reticuloendothelial system (liver, spleen, and bone marrow). It is the first parameter to decrease in iron deficiency anemia, often before clinical symptoms or changes in red cell morphology appear. **Analysis of Incorrect Options:** * **Serum Iron (A):** Measures the amount of circulating iron bound to transferrin. It fluctuates significantly due to dietary intake, diurnal variation, and acute illness, making it an unreliable measure of long-term stores. * **TIBC (C):** Total Iron Binding Capacity measures the blood's capacity to bind iron with transferrin. While it increases in iron deficiency, it is an indirect measure and can be affected by liver function and protein status. * **Transferrin Saturation (D):** This is a calculated percentage (Serum Iron/TIBC × 100). It indicates how much serum iron is actually bound but does not quantify the reserve stores in the tissues. **Clinical Pearls for NEET-PG:** * **Gold Standard:** While serum ferritin is the best *non-invasive* test, the **Prussian Blue stain of bone marrow aspirate** remains the absolute gold standard for assessing iron stores. * **Acute Phase Reactant:** Ferritin is an acute-phase reactant. Its levels may be falsely elevated in inflammatory states, malignancy, or liver disease, even if iron stores are low. * **Diagnostic Threshold:** A serum ferritin level **<15–30 ng/mL** is highly specific for iron deficiency anemia.

Question 1

Incompatible blood transfusion leads to all except?

Accepted Answer

Increased plasma prothrombin

Answer

Increased plasma bilirubin

Answer

Jaundice

Answer

Renal failure

Question 2

Which of the following statements about Sickle cell anemia is INCORRECT?

Accepted Answer

It is caused by the deletion of a gene.

Answer

It is commonly seen in people of African descent.

Answer

Red blood cell size is typically altered.

Answer

There is a substitution of valine for glutamic acid in the beta-globin chain.

Question 3

Blood platelets in stored blood do not remain functional after what duration?

Accepted Answer

24 hours

Answer

12 hours

Answer

48 hours

Answer

72 hours

Question 4

Heterozygous sickle cell anemia provides protection against which of the following?

Accepted Answer

Malaria

Answer

G6PD deficiency

Answer

Thalassemia

Answer

Dengue fever

Question 5

Which subtype of Acute Myeloid Leukemia (AML) is characterized by gum infiltration and hepatosplenomegaly?

Accepted Answer

M4 subtype

Answer

Acute lymphoblastic leukemia (ALL)

Answer

M3 subtype

Answer

M2 subtype

Question 6

Which one of the labeled boxes in the diagram below is most consistent with the expected findings for an individual with polycythemia rubra vera?

Accepted Answer

Box E

Answer

Box A

Answer

Box B

Answer

Box D

Question 7

What is the most common extranodal site for non-Hodgkin's lymphoma?

Accepted Answer

Stomach

Answer

Brain

Answer

Intestines

Answer

Tonsils

Question 8

Nuclear-cytoplasmic asynchrony is usually seen in:

Accepted Answer

Cobalamin Deficiency Anemia

Answer

Myelophthisic Anemia

Answer

Aplastic Anemia

Answer

Iron deficiency Anemia

Question 9

What is the most suitable test to assess iron stores?

Accepted Answer

Serum ferritin

Answer

Serum iron

Answer

TIBC

Answer

Transferrin saturation

Question 10

Acquired mutations in the PIGA gene give rise to which condition?

Accepted Answer

Paroxysmal Nocturnal Hemoglobinuria

Answer

Hereditary Spherocytosis

Answer

Isoimmune hemolytic anemia

Answer

Fanconi’s anemia

Hematopathology — MCQs

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