Hematopathology Practice Questions

Q: Fragmented RBCs, sliced by fibrin bands, seen in intravascular hemolysis, are known as which of the following?

Schistocytes. **Explanation:** The correct answer is **Schistocytes**. **Mechanism of Formation:** Schistocytes are fragmented red blood cells (RBCs) that result from mechanical trauma. In conditions involving **Microangiopathic Hemolytic Anemia (MAHA)**, the intravascular space is crisscrossed by fibrin strands (microthrombi). As RBCs circulate, they are literally "sliced" by these fibrin bands, leading to the loss of cell membrane and the formation of irregular, jagged fragments (helmet cells, triangular cells). **Analysis of Incorrect Options:** * **B. Spherocytes:** These are small, dark-staining RBCs lacking central pallor. They occur due to molecular defects in the cytoskeleton (Hereditary Spherocytosis) or partial phagocytosis of antibody-coated RBCs (Autoimmune Hemolytic Anemia). * **C. Leptocytes (Target Cells):** Also known as Codocytes, these have a "bullseye" appearance due to an increased surface area-to-volume ratio. They are typically seen in Thalassemia, Liver disease, and Post-splenectomy states. * **D. Burr cells (Echinocytes):** These are RBCs with short, evenly spaced blunt projections. They are most commonly associated with **Uremia**, pyruvate kinase deficiency, or as an artifact in stored blood. **High-Yield Clinical Pearls for NEET-PG:** * **Key Associations for Schistocytes:** DIC (Disseminated Intravascular Coagulation), TTP (Thrombotic Thrombocytopenic Purpura), HUS (Hemolytic Uremic Syndrome), and prosthetic heart valves. * **Diagnostic Triad of MAHA:** Anemia, Schistocytes on peripheral smear, and Thrombocytopenia. * **Bite Cells vs. Schistocytes:** Do not confuse them. Bite cells (degmacytes) are seen in **G6PD deficiency** due to splenic macrophages removing Heinz bodies.

Q: What is the most common cause of complications in blood transfusion?

Human error. **Explanation:** The most common cause of transfusion-related complications and fatalities is **Human Error**. Despite advanced screening for pathogens and immunological testing, clerical mistakes remain the leading risk factor. These errors typically occur during sample labeling, patient identification at the bedside, or issuing the wrong blood unit from the blood bank [1]. This leads to **ABO incompatibility**, which can trigger life-threatening acute hemolytic transfusion reactions (AHTR). **Analysis of Options:** * **Anaphylaxis (Option B):** While common among allergic reactions, it is far less frequent than clerical errors. It is usually caused by IgA deficiency in the recipient who has anti-IgA antibodies [1]. * **Graft-versus-host disease (Option C):** GVHD is a rare but highly fatal complication occurring in immunocompromised patients. It is prevented by gamma irradiation of blood products, not a "most common" occurrence. * **Presensitization (Option D):** This refers to the presence of pre-formed antibodies (from prior transfusions or pregnancies). While it causes delayed hemolytic reactions, modern cross-matching techniques have significantly reduced its incidence compared to human-led bedside errors. **High-Yield Clinical Pearls for NEET-PG:** * **Most common overall reaction:** Febrile Non-Hemolytic Transfusion Reaction (FNHTR), caused by cytokines or HLA antibodies. * **Most common cause of transfusion-related death:** Historically ABO incompatibility (human error) [1], but in many modern registries, **TRALI** (Transfusion-Related Acute Lung Injury) is cited as the leading cause of mortality. * **Golden Rule:** Always perform a double-check of patient identity and blood bag labels at the bedside to prevent the most common cause of morbidity. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 673-674.

Q: A 27-year-old black man develops sudden intravascular hemolysis 2 days after receiving the antimalarial drug primaquine, resulting in a decreased hematocrit, hemoglobinemia, and hemoglobinuria. Examination of the peripheral blood film is given. What is the most likely diagnosis?

Glucose-6-phosphate dehydrogenase deficiency. ***Glucose-6-phosphate dehydrogenase deficiency*** - Classic presentation of **G6PD deficiency** triggered by an **oxidant drug** (primaquine) in a high-risk population (African male). - Peripheral blood smear shows characteristic **bite cells** (degmacytes), **blister cells**, and **Heinz bodies** indicating oxidative damage to red blood cells. *Hereditary spherocytosis* - Presents with **spherocytes** on blood smear and is associated with **osmotic fragility**, not drug-induced hemolysis. - Usually has a **positive family history** and **splenomegaly**, lacking the acute oxidant trigger seen here. *Paroxysmal nocturnal hemoglobinuria* - Characterized by **complement-mediated hemolysis** that typically occurs at night or during sleep. - Blood smear shows **normocytic anemia** without the specific oxidative damage morphology seen in G6PD deficiency. *Microangiopathic hemolytic anemia* - Blood smear shows **schistocytes** (fragmented red blood cells) due to mechanical damage in small vessels. - Associated with conditions like **thrombotic thrombocytopenic purpura** or **hemolytic uremic syndrome**, not drug-induced oxidative stress.

Q: A 56-year-old male presents with low back pain, weight loss, fatigue, and recurrent sinus infections. He has no history of trauma. Examination reveals focal tenderness at the T10 level. Laboratory investigations show Hb of 9 g/dl and deranged renal function tests. A skull X-ray was performed. Bone marrow biopsy and serum protein electrophoresis are planned. What is the characteristic abnormality expected on the peripheral blood film?

Rouleaux formation. The clinical presentation of bone pain (low back pain), constitutional symptoms (weight loss, fatigue), recurrent infections, and renal impairment in an elderly male is highly suggestive of **Multiple Myeloma (MM)** [1]. The "CRAB" features (Calcium elevation, Renal insufficiency, Anemia, and Bone lesions) are classic indicators [1]. **1. Why Rouleaux formation is correct:** In Multiple Myeloma, there is a monoclonal proliferation of plasma cells leading to the overproduction of monoclonal (M) proteins (immunoglobulins) [1]. These high levels of paraproteins reduce the zeta potential (negative charge) on the surface of Red Blood Cells (RBCs). This allows RBCs to stack together like a "pile of coins," a phenomenon known as **Rouleaux formation** [2]. This is the characteristic peripheral smear finding in MM and is also responsible for the characteristically high ESR seen in these patients [1]. **2. Analysis of Incorrect Options:** * **Anemia (A):** While the patient has anemia (Hb 9 g/dl), it is a *finding*, not a *characteristic morphological abnormality* on the film. * **Pelger-Huet anomaly (B):** This refers to hyposegmented neutrophils, typically seen in Myelodysplastic Syndromes (MDS) or congenital conditions, not MM. * **Neutrophilia (D):** Patients with MM are often neutropenic due to marrow infiltration or have normal counts; neutrophilia is not a characteristic feature. **Clinical Pearls for NEET-PG:** * **Skull X-ray:** Look for "punched-out" lytic lesions [1]. * **Diagnosis:** Gold standard is Bone Marrow Biopsy (>10% clonal plasma cells) [1]. * **Bence-Jones Proteins:** These are free light chains found in urine; they do not show up on standard dipsticks [1]. * **M-Spike:** Seen on Serum Protein Electrophoresis (SPEP), usually in the Gamma globulin region [1].

Question 1

Presence of >10% plasma cells with no lytic lesion and M protein in serum is seen in?

Accepted Answer

Smoldering myeloma

Answer

Multiple myeloma

Answer

Monoclonal gammopathy of unknown significance

Answer

Non-secretory myeloma

Question 2

Fragmented RBCs, sliced by fibrin bands, seen in intravascular hemolysis, are known as which of the following?

Accepted Answer

Schistocytes

Answer

Spherocytes

Answer

Leptocytes

Answer

Burr cells

Question 3

P.N.H is associated with all of the following conditions, except?

Accepted Answer

Increased LAP scores

Answer

Aplastic anemia

Answer

Venous thrombosis

Answer

Iron deficiency anemia

Question 4

The HAM test is used to assess for which of the following?

Accepted Answer

G.P.I. anchor protein deficiency

Answer

Complement defect

Answer

Spectrin defect

Answer

Mannose binding protein deficiency

Question 5

Which of the following are the histological features of classical Hodgkin's disease?

Accepted Answer

Both neoplastic and non-neoplastic cells are seen

Answer

Mixed cellularity seen in the background

Answer

Neoplastic cells more than non-neoplastic cells

Answer

CD15 and CD34 are seen

Question 6

What is the most common cause of complications in blood transfusion?

Accepted Answer

Human error

Answer

Anaphylaxis

Answer

Graft-versus-host disease (GVHD)

Answer

Presensitization

Question 7

A 20-year-old carpenter presents with an enlarged and tender lymph node in the axilla due to a wound infection on his left thumb. A lymph node biopsy shows follicular enlargement and hyperemia, with sinuses filled with neutrophils. What is the most likely diagnosis?

Accepted Answer

Suppurative lymphadenitis

Answer

Castleman disease

Answer

Interfollicular hyperplasia

Answer

Sinus histiocytosis

Question 8

A 27-year-old black man develops sudden intravascular hemolysis 2 days after receiving the antimalarial drug primaquine, resulting in a decreased hematocrit, hemoglobinemia, and hemoglobinuria. Examination of the peripheral blood film is given. What is the most likely diagnosis?

Accepted Answer

Glucose-6-phosphate dehydrogenase deficiency

Answer

Hereditary spherocytosis

Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Microangiopathic hemolytic anemia

Question 9

All of the following are true regarding Von Willebrand's disease EXCEPT:

Accepted Answer

Normal Ristocetin test

Answer

Factor VIII C deficiency

Answer

Bleeding time is prolonged

Answer

Defective platelet aggregation

Question 10

A 56-year-old male presents with low back pain, weight loss, fatigue, and recurrent sinus infections. He has no history of trauma. Examination reveals focal tenderness at the T10 level. Laboratory investigations show Hb of 9 g/dl and deranged renal function tests. A skull X-ray was performed. Bone marrow biopsy and serum protein electrophoresis are planned. What is the characteristic abnormality expected on the peripheral blood film?

Accepted Answer

Rouleaux formation

Answer

Anemia

Answer

Pelger-Huet anomaly

Answer

Neutrophilia

Hematopathology — MCQs

Hematopathology — MCQs

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