Hematopathology Practice Questions

Q: All of the following are true regarding Anemia of Chronic Disease, except?

Decreased ferritin. **Explanation:** Anemia of Chronic Disease (ACD), also known as Anemia of Inflammation, is primarily mediated by **Hepcidin**, an acute-phase reactant produced by the liver in response to inflammatory cytokines (especially IL-6) [1]. **Why Option B is the Correct Answer (The "Except" statement):** In ACD, **Serum Ferritin is typically increased or normal**, not decreased. Ferritin acts as an acute-phase reactant; inflammation causes the body to sequester iron within storage sites (macrophages and hepatocytes) to withhold it from potential pathogens. A **decreased ferritin** is the hallmark of **Iron Deficiency Anemia (IDA)** [1], making this the false statement regarding ACD [2]. **Analysis of Incorrect Options:** * **Option A (Decreased serum iron):** True. Hepcidin causes the degradation of ferroportin channels, preventing iron release from macrophages and absorption from the gut, leading to low circulating serum iron (hypoferremia) [1]. * **Option C (Decreased TIBC):** True. In states of chronic inflammation, the body downregulates the synthesis of Transferrin (measured as TIBC) to limit iron availability [1]. This helps differentiate ACD from IDA (where TIBC is increased) [2]. * **Option D (Increased bone marrow iron):** True. Because iron is "trapped" inside the reticuloendothelial system (macrophages) and cannot be utilized for erythropoiesis, bone marrow aspirate stained with Prussian blue shows abundant iron stores. **High-Yield Clinical Pearls for NEET-PG:** * **Pathophysiology:** High Hepcidin → Low Ferroportin → Iron Sequestration [1]. * **Morphology:** Usually Normocytic Normochromic; can become Microcytic Hypochromic in long-standing cases [1]. * **Gold Standard Diagnosis:** Bone marrow iron staining (Prussian Blue), though rarely done clinically. * **Key Differentiator:** The **Soluble Transferrin Receptor (sTfR)** index is normal in ACD but elevated in IDA [2].

Q: An elevated White Blood Cell (WBC) count is seen in all of the following conditions except?

Typhoid. The correct answer is **Typhoid (Option A)**. In clinical hematology, most bacterial infections cause leukocytosis (elevated WBC count) [3]. However, Typhoid fever (Enteric fever) is a classic exception. It typically presents with **leukopenia** (decreased WBC count) or a normal WBC count with a relative lymphocytosis. This occurs due to the sequestration of leukocytes in the spleen and bone marrow depression by the *Salmonella typhi* endotoxin [2]. **Analysis of other options:** * **Pertussis (Option B):** Unlike most bacterial infections that cause neutrophilia, *Bordetella pertussis* causes a marked **lymphocytic leukocytosis** [1]. This is due to "pertussis toxin," which prevents lymphocytes from leaving the blood and entering the lymph nodes. * **Lymphoreticular malignancy (Option C):** Conditions like Chronic Lymphocytic Leukemia (CLL) or lymphomas in the leukemic phase are characterized by the uncontrolled proliferation of white cells, leading to significantly elevated WBC counts [1]. * **Tuberculosis (Option D):** TB is a chronic granulomatous infection that typically presents with mild to moderate leukocytosis, often with an increase in monocytes or lymphocytes [1], [3]. In cases of miliary TB, a "leukemoid reaction" (WBC >50,000/µL) can sometimes occur. **High-Yield Clinical Pearls for NEET-PG:** * **Leukopenia in Infections:** Common causes include Typhoid [2], Brucellosis, Kala-azar, and viral infections (like Dengue or HIV). * **Eosinopenia:** A characteristic finding in the early stages of Typhoid fever (disappearance of eosinophils). * **Leukemoid Reaction:** Defined as a reactive increase in WBC count >50,000/µL. It is commonly seen in severe infections (Sepsis, TB) [3] or acute hemolysis, mimicking leukemia but with a high Leukocyte Alkaline Phosphatase (LAP) score.

Q: Acute myeloid leukemia (AML) is characterized by which of the following findings?

Auer rods. **Explanation:** **Acute Myeloid Leukemia (AML)** is a clonal proliferation of myeloid precursors (blasts) in the bone marrow. The presence of **Auer rods** is a pathognomonic hallmark of AML [1]. These are needle-like, azurophilic cytoplasmic inclusions formed by the crystallization of fused primary granules (lysosomes) containing **myeloperoxidase (MPO)** [2]. They are most commonly seen in the M1, M2, M3 (APML), and M4 subtypes of the FAB classification. **Analysis of Incorrect Options:** * **A. Philadelphia chromosome [t(9;22)]:** This is the hallmark of **Chronic Myeloid Leukemia (CML)**, involving the *BCR-ABL1* fusion gene. While it can occur in some cases of B-ALL or AML (as a poor prognostic marker), it is not a defining characteristic of AML. * **C. Hemolytic anemia:** While AML patients present with anemia due to bone marrow infiltration (myelophthisis), it is typically **normocytic normochromic** and non-hemolytic. * **D. Dohle bodies:** These are light blue, peripheral cytoplasmic inclusions (remnants of rough endoplasmic reticulum) found in **neutrophils** during states of inflammation, infection, or burns (toxic changes), rather than in leukemic blasts. **High-Yield Clinical Pearls for NEET-PG:** * **M3 Subtype (APML):** Characterized by "faggot cells" (bundles of Auer rods) and a high risk of **DIC** due to the release of procoagulants [1]. * **Diagnosis:** According to WHO criteria, AML requires **≥20% blasts** in the peripheral blood or bone marrow. * **Cytochemistry:** AML blasts are typically **MPO positive** and Sudan Black B positive, helping differentiate them from ALL. **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. [2] 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. 621-622.

Q: Which of the following conditions exhibits X-linked recessive inheritance?

G6PD deficiency. **Explanation:** **1. Correct Option: G6PD Deficiency** Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is an **X-linked recessive** enzymopathy. The G6PD gene is located on the long arm of the X chromosome (Xq28). Because of this inheritance pattern, the condition primarily affects males, while females are typically asymptomatic carriers [1]. However, females can manifest the disease due to **unfavorable lyonization** (random X-inactivation). The deficiency leads to inadequate NADPH production, making RBCs susceptible to oxidative stress, resulting in hemolysis and the formation of **Heinz bodies** and **Bite cells**. **2. Incorrect Options:** * **Sickle Cell Anaemia:** This is an **Autosomal Recessive** disorder caused by a point mutation (Glu → Val) in the β-globin chain. * **Thalassemia:** Both Alpha and Beta thalassemias are **Autosomal Recessive** conditions involving quantitative defects in globin chain synthesis. * **Hereditary Spherocytosis:** This is most commonly inherited in an **Autosomal Dominant** pattern (approx. 75% of cases), involving defects in RBC membrane proteins like Ankyrin or Spectrin. **3. NEET-PG High-Yield Pearls:** * **Common Triggers:** Fava beans, infections, and drugs (Primaquine, Sulphonamides, Nitrofurantoin). * **Morphology:** Heinz bodies (denatured hemoglobin) are visualized with **Supravital stains** (Crystal violet/Methylene blue). Bite cells (Degmacytes) are formed in the splenic sinusoids. * **Protection:** G6PD deficiency provides a selective advantage against *Plasmodium falciparum* malaria. * **Timing of Test:** Do not perform the G6PD enzyme assay during an acute hemolytic episode, as young reticulocytes have normal enzyme levels, leading to a **false-negative** result. Wait 6–8 weeks. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, p. 151.

Question 1

All of the following are true regarding Anemia of Chronic Disease, except?

Accepted Answer

Decreased ferritin

Answer

Decreased serum iron

Answer

Decreased total iron-binding capacity

Answer

Increased bone marrow iron

Question 2

Thrombocytosis is seen in which of the following conditions?

Accepted Answer

Haemolytic anaemia

Answer

Osteopetrosis

Answer

Disseminated intravascular coagulation

Answer

Thiazide therapy

Question 3

An elevated White Blood Cell (WBC) count is seen in all of the following conditions except?

Accepted Answer

Typhoid

Answer

Pertussis

Answer

Lymphoreticular malignancy

Answer

Tuberculosis

Question 4

Acute myeloid leukemia (AML) is characterized by which of the following findings?

Accepted Answer

Auer rods

Answer

Philadelphia chromosome

Answer

Hemolytic anemia

Answer

Dohle bodies

Question 5

Eosin-5-maleimide flow cytometry is used for the diagnosis of which condition?

Accepted Answer

Hereditary spherocytosis

Answer

Glucose-6-phosphate dehydrogenase deficiency

Answer

Sickle cell anemia

Answer

Alpha thalassemia

Question 6

Which of the following is NOT a characteristic feature of Chronic Lymphocytic Leukemia (CLL)?

Accepted Answer

Onset typically in individuals over 50 years of age, with a slight predilection for males

Answer

Presence of small lymphocytes in peripheral smear

Answer

Hepatosplenomegaly

Answer

Expression of ZAP-70 is a marker

Question 7

A patient presents with a platelet count of 700 x 10^9/L with abnormalities in size, shape, and granularity of platelets. The WBC count is 12 x 10^9/L, hemoglobin is 11 g/dL, and the Philadelphia chromosome is absent. What is the most likely diagnosis?

Accepted Answer

Essential thrombocythemia

Answer

Polycythemia vera

Answer

Chronic myeloid leukemia

Answer

Leukemoid reaction

Question 8

Giant platelets are seen in all the following conditions except:

Accepted Answer

Glanzmann thrombasthenia

Answer

Bernard-Soulier syndrome

Answer

May-Hegglin anomaly

Answer

Gray platelet syndrome

Question 9

All of the following can cause aplastic anemia except?

Accepted Answer

Wiskott-Aldrich syndrome

Answer

Fanconi's anemia

Answer

Dyskeratosis congenital

Answer

Reticular dysgenesis

Question 10

Which of the following conditions exhibits X-linked recessive inheritance?

Accepted Answer

G6PD deficiency

Answer

Sickle cell anaemia

Answer

Thalassemia

Answer

Hereditary spherocytosis

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?