Hematopathology Practice Questions

Q: Burr cells are seen in which condition?

Uremia. **Burr cells**, also known as **Echinocytes**, are mature red blood cells characterized by multiple, short, blunt, and evenly spaced circumferential projections. **1. Why Uremia is correct:** In **Uremia** (chronic kidney disease), the accumulation of metabolic waste products and toxins in the plasma alters the osmotic environment and the lipid composition of the RBC membrane [1]. This leads to an expansion of the outer leaflet of the lipid bilayer relative to the inner leaflet, resulting in the characteristic "spiculated" appearance. Burr cells are a classic peripheral smear finding in renal failure and are reversible if the cells are placed in healthy serum [2]. **2. Why the other options are incorrect:** * **Gastric Carcinoma:** While not the primary association, gastric carcinoma is classically associated with **Acanthocytes** (Spur cells) or microangiopathic hemolytic anemia (MAHA) if disseminated, but not specifically Burr cells. * **Hepatocellular & Ovarian Carcinoma:** These do not typically present with Burr cells. Liver disease is more commonly associated with **Target cells** (Codocytes) or **Acanthocytes** (due to abnormal cholesterol metabolism). **3. High-Yield Clinical Pearls for NEET-PG:** * **Burr Cells vs. Acanthocytes:** Burr cells have *regular, even* projections; Acanthocytes have *irregular, finger-like* projections. * **Common Causes of Burr Cells:** Uremia (most common), Pyruvate Kinase deficiency, and Hypophosphatemia. * **Acanthocytes (Spur Cells)** are seen in Abetalipoproteinemia and severe Liver Disease. * **Schistocytes** (Fragmented cells) are seen in MAHA (DIC, HUS, TTP). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. The Pancreas, pp. 902-905. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 539-540.

Q: Which of the following statements about acute hemolytic blood transfusion reactions is true?

Complement mediated hemolysis is seen.. **Explanation:** **Acute Hemolytic Transfusion Reaction (AHTR)** is a medical emergency typically caused by **ABO incompatibility** [2]. 1. **Why Option A is correct:** AHTR is a classic example of **Type II Hypersensitivity**. When incompatible blood is transfused, pre-existing host IgM antibodies (isohemagglutinins) bind to donor red cell antigens. This triggers the **classical complement pathway**, leading to the formation of the Membrane Attack Complex (MAC) [2]. This results in rapid **intravascular hemolysis**, releasing free hemoglobin into the plasma [1]. 2. **Why other options are incorrect:** * **Option B:** AHTR is a **Type II hypersensitivity** (antibody-mediated cytotoxicity), not Type III (immune-complex mediated). * **Option C:** These reactions are **highly life-threatening**. They can rapidly progress to disseminated intravascular coagulation (DIC), shock, and multi-organ failure [2]. * **Option D:** Renal blood flow is **severely compromised**. Free hemoglobin is nephrotoxic and can cause **Acute Tubular Necrosis (ATN)** [1]. Furthermore, systemic hypotension and DIC-induced microthrombi lead to acute renal failure. **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Clerical/Administrative error (wrong blood to wrong patient) [2]. * **Triad of symptoms:** Fever/Chills, Flank pain (due to renal ischemia), and Hemoglobinuria [1]. * **Lab Findings:** Positive Direct Antiglobulin Test (DAT/Coombs), decreased haptoglobin, and increased indirect bilirubin [1]. * **Management:** Immediate cessation of transfusion and aggressive IV fluid resuscitation to maintain urine output. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 639-640. [2] 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: Which of the following is the most common cause of transfusion-associated hepatitis?

Hepatitis B. The correct answer is **Hepatitis B (HBV)**. While Hepatitis C was historically the most common cause of post-transfusion hepatitis before the discovery of the virus and the implementation of rigorous screening, modern nucleic acid testing (NAT) has significantly reduced the risk for both HBV and HCV. However, **Hepatitis B remains the most common** transfusion-transmitted viral infection (TTI) globally and in India. This is primarily due to the "occult" HBV infection (HBsAg negative but DNA positive) and the longer window period compared to other viruses, which allows it to occasionally bypass standard screening protocols. **Analysis of Incorrect Options:** * **Hepatitis A:** It is primarily transmitted via the fecal-oral route [1]. While transient viremia occurs, it is an extremely rare cause of transfusion-associated hepatitis because it does not have a chronic carrier state. * **Hepatitis C:** Formerly the leading cause of "Non-A, Non-B" post-transfusion hepatitis. Since the introduction of highly sensitive NAT, the risk has plummeted to less than 1 in 2 million units in developed regions, making it less common than HBV. * **Hepatitis D:** This is a defective virus that requires the presence of HBsAg to replicate. It is only transmitted alongside HBV and is not considered an independent primary cause of transfusion-associated hepatitis. **High-Yield Pearls for NEET-PG:** * **Most common TTI overall:** Hepatitis B. * **Most common cause of post-transfusion purpura:** Antibodies against HPA-1a. * **Most common cause of transfusion-related mortality:** TRALI (Transfusion-Related Acute Lung Injury). * **Window Period:** HBV has a longer window period (~30-60 days) compared to HIV (~7-10 days) or HCV (~3-5 days) when using NAT. [2]

Q: A 3-year-old child presented with anemia and thrombocytopenia. On examination, there was massive splenomegaly. A bone marrow aspiration revealed specific cellular findings. What is the diagnosis?

Gaucher disease. ***Gaucher disease*** - The combination of **anemia**, **thrombocytopenia**, and **massive splenomegaly** with specific cellular findings on bone marrow aspiration strongly suggests Gaucher disease. - Bone marrow reveals pathognomonic **Gaucher cells** with characteristic **wrinkled tissue paper cytoplasm** due to **glucocerebrosidase deficiency** leading to glucocerebroside accumulation. *Mucopolysaccharidosis* - Typically presents with **coarse facial features**, **hepatosplenomegaly**, and **developmental delay** rather than isolated hematological abnormalities. - Bone marrow shows **foamy macrophages** filled with **glycosaminoglycans**, not the characteristic wrinkled cytoplasm seen in Gaucher cells. *Acute Leukemia* - Would show **blast cells** on bone marrow aspiration with high **white blood cell count** and **lymphadenopathy**. - The **specific cellular findings** mentioned in the question point toward storage cells rather than malignant blasts. *Thalassemia* - Primarily causes **anemia** with **target cells** and **nucleated RBCs** on peripheral smear, but **thrombocytopenia** is uncommon. - Bone marrow shows **erythroid hyperplasia** rather than the specific storage cells characteristic of lysosomal storage disorders.

Q: Which of the following is NOT a B-cell marker?

CD15. The identification of cell surface markers (Cluster of Differentiation or CD) is a high-yield topic in NEET-PG, particularly for differentiating lymphocyte lineages. **Why CD15 is the correct answer:** **CD15** is primarily a marker for **Granulocytes** (Neutrophils and Eosinophils) and is also expressed on **Reed-Sternberg cells** in Hodgkin Lymphoma (along with CD30). It is not expressed on B-cells. Therefore, it is the correct "NOT" option. **Why the other options are incorrect (B-cell markers):** * **CD19:** This is the most ubiquitous B-cell marker. It is expressed from the earliest stages of B-cell development (pro-B cell) until just before terminal differentiation into plasma cells. * **CD21:** Also known as Complement Receptor 2 (CR2). It is found on mature B-cells and serves as the receptor for the **Epstein-Barr Virus (EBV)**. * **CD24:** This is a glycoprotein expressed on the surface of B-lymphocytes from the pre-B to the mature B-cell stage. **High-Yield Clinical Pearls for NEET-PG:** * **Pan-B cell markers:** CD19, CD20, CD22. * **CD10:** Also known as **CALLA** (Common Acute Lymphoblastic Leukemia Antigen), found on pre-B cells. * **CD5:** Normally a T-cell marker, but its expression on B-cells is characteristic of **Chronic Lymphocytic Leukemia (CLL)** and **Mantle Cell Lymphoma**. * **CD15 & CD30:** The classic "duo" for identifying Reed-Sternberg cells in Hodgkin Lymphoma (except for the Lymphocyte Predominant type).

Question 1

Burr cells are seen in which condition?

Accepted Answer

Uremia

Answer

Hepatocellular carcinoma

Answer

Gastric carcinoma

Answer

Ovarian carcinoma

Question 2

Which of the following statements about acute hemolytic blood transfusion reactions is true?

Accepted Answer

Complement mediated hemolysis is seen.

Answer

Type III hypersensitivity is responsible for most cases.

Answer

These reactions are rarely life-threatening.

Answer

Renal blood flow is always maintained.

Question 3

Gandy Gamma bodies are seen in which of the following conditions?

Accepted Answer

Sickle cell anemia

Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

Vitamin B12 deficiency

Question 4

Disseminated intravascular coagulation (DIC) is commonly seen in which of the following conditions?

Accepted Answer

Acute promyelocytic leukemia

Answer

Acute myelomonocytic leukemia

Answer

Chronic myeloid leukemia

Answer

Autoimmune hemolytic anemia

Question 5

Which of the following is the most common cause of transfusion-associated hepatitis?

Accepted Answer

Hepatitis B

Answer

Hepatitis A

Answer

Hepatitis C

Answer

Hepatitis D

Question 6

A 3-year-old child presented with anemia and thrombocytopenia. On examination, there was massive splenomegaly. A bone marrow aspiration revealed specific cellular findings. What is the diagnosis?

Accepted Answer

Gaucher disease

Answer

Mucopolysaccharidosis

Answer

Acute Leukemia

Answer

Thalassemia

Question 7

What is the investigation of choice to confirm sickle cell disease?

Accepted Answer

High-performance liquid chromatography

Answer

Tandem mass spectrometry

Answer

Gel electrophoresis

Answer

Naked eye single tube red cell osmotic fragility test

Question 8

What type of antibodies are typically found in Idiopathic Thrombocytopenic Purpura (ITP)?

Accepted Answer

IgG

Answer

IgM

Answer

IgE

Answer

IgD

Question 9

Which of the following is NOT a B-cell marker?

Accepted Answer

CD15

Answer

CD19

Answer

CD21

Answer

CD24

Question 10

A single nucleotide change in a codon on chromosome 11 causes valine to replace glutamic acid at the sixth position of the beta chain of hemoglobin. What is the resulting condition?

Accepted Answer

Sickle cell anemia

Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

Paroxysmal nocturnal hemoglobinuria

Hematopathology — MCQs

Hematopathology — MCQs

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