Hematopathology Practice Questions

Q: How long can blood be stored with CPD-A?

28 days. **Explanation:** The shelf life of stored blood is determined by the anticoagulant-preservative solution used, which maintains red cell viability and prevents clotting. **1. Why 28 days is correct:** **CPD-A (Citrate Phosphate Dextrose Adenine)** is a standard preservative used in blood banking. The addition of **Adenine** is the critical factor; it acts as a substrate for red blood cells to synthesize ATP, which maintains the integrity of the red cell membrane during storage. This enhancement extends the shelf life of the blood to **28 days**. (Note: Some modern formulations like CPDA-1 can extend this to 35 days, but in the context of standard CPD-A, 28 days is the established duration). **2. Analysis of Incorrect Options:** * **A (12 days) & B (21 days):** These durations are associated with older or less efficient preservatives. **ACD (Acid Citrate Dextrose)** and **CPD (Citrate Phosphate Dextrose)** without adenine typically allow for a shelf life of only **21 days**. * **D (48 days):** This exceeds the metabolic capacity of red cells in standard CPD-A. Storage beyond 35-42 days usually requires additive solutions like SAGM (Saline Adenine Glucose Mannitol). **3. NEET-PG High-Yield Pearls:** * **Citrate:** Acts as the anticoagulant by chelating calcium. * **Phosphate:** Acts as a buffer to prevent a rapid drop in pH (maintaining 2,3-DPG levels). * **Dextrose:** Provides the energy source for glycolysis. * **Storage Temperature:** Blood must be stored at **2°C to 6°C**. * **The "Storage Lesion":** During storage, there is a decrease in pH, 2,3-DPG, and Sodium, while there is an **increase in Potassium** (important for pediatric/renal patients).

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: Which of the following is NOT a feature of hereditary spherocytosis?

Increased RBC surface area to volume ratio. **Explanation:** Hereditary Spherocytosis (HS) is a common inherited hemolytic anemia caused by defects in the red blood cell (RBC) membrane proteins (most commonly **Ankyrin**, followed by Band 3 and Spectrin). **Why Option B is the Correct Answer:** In HS, the molecular defect leads to a loss of membrane fragments (blebbing). As the cell loses membrane surface area while maintaining its internal volume, it is forced to assume the most geometrically efficient shape—a sphere. Therefore, HS is characterized by a **decreased surface area-to-volume ratio**. This makes the cells rigid and prone to splenic sequestration and hemolysis. **Analysis of Incorrect Options:** * **Option A (Autosomal dominant):** Approximately 75% of HS cases follow an autosomal dominant inheritance pattern, making this a true feature. * **Option C (Increased MCHC):** This is a **hallmark finding** in HS. As the cell loses membrane and dehydrates, the hemoglobin becomes more concentrated. MCHC is typically >36 g/dL. * **Option D (Normal or decreased MCV):** Due to the loss of membrane surface, the average volume of the RBC (MCV) is usually low-normal or slightly decreased [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Test:** Eosin-5-maleimide (EMA) binding test (Flow cytometry). * **Screening Test:** Osmotic Fragility Test (shows increased fragility) [1]. * **Peripheral Smear:** Spherocytes (small, dark RBCs lacking central pallor) and polychromasia (reticulocytosis) [1]. * **Clinical Triad:** Anemia, Jaundice, and Splenomegaly. * **Complications:** Pigmented gallstones (calcium bilirubinate) and aplastic crisis (associated with Parvovirus B19) [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 597-598.

Question 1

How long can blood be stored with CPD-A?

Accepted Answer

28 days

Answer

12 days

Answer

21 days

Answer

48 days

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

Which of the following is NOT a feature of hereditary spherocytosis?

Accepted Answer

Increased RBC surface area to volume ratio

Answer

Autosomal dominant inheritance

Answer

Increased MCHC

Answer

Normal or decreased MCV

Question 4

Hypersegmented neutrophils are a feature of?

Accepted Answer

Megaloblastic anemia

Answer

Hemosiderosis

Answer

Sideroblastic anemia

Answer

Thalassemia

Question 5

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 6

Which of the following protein defects can cause hereditary spherocytosis?

Accepted Answer

Glycophorin C

Answer

Ankyrin

Answer

Palladin

Answer

Anion transport protein

Question 7

All of the following can be seen in bone marrow of myelodysplastic syndrome (MDS) cases, except:

Accepted Answer

Cloud-like megakaryocytes

Answer

Pseudo-Pelger-Huet cells

Answer

Ring sideroblasts

Answer

Megaloblastic change in erythroid precursors

Question 8

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 9

Which of the following conditions is NOT associated with Histiocytosis X?

Accepted Answer

Torres syndrome

Answer

Hand-Schüller-Christian disease

Answer

Eosinophilic granuloma

Answer

Letterer-Siwe syndrome

Question 10

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

Hematopathology — MCQs

Hematopathology — MCQs

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