Hematopathology Practice Questions

Q: The image shows electrophoresis report of multiple myeloma. The spike is present in:

Gamma globulin. ***Gamma globulin*** - Multiple myeloma is characterized by the overproduction of a single type of **monoclonal immunoglobulin** (M-protein) by plasma cells [1]. - These M-proteins are typically found in the **gamma region** of the serum protein electrophoresis (SPEP) as a distinct, sharp spike [2]. *Alpha 1 globulin* - This region primarily contains proteins like **alpha-1 antitrypsin** and **alpha-fetoprotein**. - A spike in this region is not characteristic of multiple myeloma and would suggest other conditions. *Alpha 2 globulin* - This region includes proteins such as **haptoglobin**, **alpha-2 macroglobulin**, and **ceruloplasmin**. - An increase in this region is often seen in inflammatory conditions or nephrotic syndrome, not typically multiple myeloma. *Beta globulin* - The beta region contains proteins like **transferrin**, **complement C3**, and **LDL**. - While some M-proteins can migrate to the beta region, the classic and most common location for the monoclonal spike in multiple myeloma is the gamma region. **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. 606-609. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 616-617.

Q: Which instrument is shown below?

Automated hematology analyzer. ***Automated hematology analyzer*** - The image displays a device that processes blood samples, showing a screen with various blood cell parameters and histograms, which is characteristic of an **automated hematology analyzer**. - This instrument is designed to perform a **complete blood count (CBC)**, including quantification and differentiation of red blood cells (RBCs), white blood cells (WBCs), and platelets. *Pilocarpine iontophoresis* - This is a diagnostic test primarily used for **cystic fibrosis**, measuring the chloride concentration in sweat. - The setup typically involves electrodes and a collection device on the skin, which is visually distinct from the machine shown. *Flame Photometry* - **Flame photometry** is a technique used to determine the concentration of certain metal ions (like sodium, potassium, lithium) in a sample. - It involves atomizing a liquid sample into a flame and measuring the emitted light, which does not match the illustrated instrument. *NESTROFT* - **NESTROFT (Naked Eye Single Tube Red Cell Osmotic Fragility Test)** is a simple screening test for thalassemia. - It involves observing the hemolysis of red blood cells in a hypotonic saline solution in a test tube, and it is not an automated instrument as depicted. *Coagulation analyzer* - A **coagulation analyzer** measures clotting parameters such as PT, aPTT, and INR to assess hemostasis and coagulation disorders. - While it also processes blood samples, it focuses on **clotting factors** rather than cell counts and displays different parameters than those shown in the image.

Q: The following electron microscopy picture is a cytoplasmic feature seen in:

Histiocytosis X. ***Histiocytosis X*** - The electron microscopy picture likely shows **Birbeck granules**, which are characteristic cytoplasmic features of **Langerhans cells** [1]. - **Langerhans cell histiocytosis (Histiocytosis X)** is a disorder characterized by the proliferation of these abnormal Langerhans cells [1]. *Neuroblastoma* - Neuroblastoma is a tumor of neural crest origin, and its cells typically show **neurosecretory granules** on electron microscopy. - It does not exhibit Birbeck granules, which are specific to Langerhans cells. *Chloroma* - Chloroma (also known as granulocytic sarcoma) is an extramedullary manifestation of **acute myeloid leukemia (AML)**. - Electron microscopy of chloroma cells would show features of immature myeloid cells, such as **azurophilic granules**, not Birbeck granules. *Plasmacytoma* - Plasmacytoma is a localized proliferation of **plasma cells**. - Electron microscopy of plasma cells would reveal abundant **rough endoplasmic reticulum** and a prominent Golgi apparatus, reflecting their role in antibody production, not Birbeck granules. **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. 630.

Q: The image shows:

Plasma cells. ***Plasma cells*** - The image likely depicts cells with an **eccentric nucleus**, **perinuclear halo (hof)**, and abundant basophilic cytoplasm, which are characteristic features of **plasma cells**. - These cells are terminally differentiated **B lymphocytes** responsible for antibody production. *Langerhans cells* - Langerhans cells are **dendritic cells** found in the epidermis, characterized by a **multilobulated nucleus** and **Birbeck granules** on electron microscopy. - They are antigen-presenting cells and do not typically exhibit the morphology shown. *Reed Sternberg cells* - Reed-Sternberg cells are large, **multinucleated cells** with prominent eosinophilic nucleoli, often described as having an "**owl's eye**" appearance, pathognomonic for **Hodgkin lymphoma** [1]. - Their morphology is distinct from the cells typically seen in the image. *CMV infected cells* - Cytomegalovirus (CMV) infected cells are typically **enlarged (cytomegalic)** and contain characteristic **intranuclear and intracytoplasmic inclusions**, often described as an "**owl's eye**" appearance due to the large central inclusion. - While they can have an eccentric nucleus, the overall morphology and presence of inclusions would differentiate them from plasma cells. **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. 614-618.

Q: Name the anticoagulant used in the traditional diluted Westergren method shown below.

Trisodium citrate. ***Trisodium citrate*** - The image displays a method for measuring **Erythrocyte Sedimentation Rate (ESR)**, typically performed using the **Westergren method**. - In the traditional diluted Westergren method, **trisodium citrate** is the standard anticoagulant used to prevent blood coagulation, allowing red blood cells to settle over time. Note that modified methods may use EDTA-anticoagulated blood. *EDTA* - **EDTA (ethylenediaminetetraacetic acid)** is a common anticoagulant, primarily used for **hematology tests** such as complete blood counts (CBC), as it preserves cell morphology. - While it prevents clotting, it is not the standard anticoagulant for the Westergren ESR method, as it can cause red blood cell shrinkage affecting sedimentation. *Heparin* - **Heparin** acts as an anticoagulant by enhancing the activity of **antithrombin III**, and is commonly used for tests such as blood gas analysis. - It interferes with the sedimentation rate in ESR measurements, making it unsuitable for this specific test. *Dalteparin* - **Dalteparin** is a type of **low molecular weight heparin (LMWH)** used therapeutically as an anticoagulant to prevent and treat blood clots. - It is not used as an in-vitro anticoagulant for blood collection tubes or lab diagnostic tests like ESR. *Sodium fluoride* - **Sodium fluoride** is primarily an **antiglycolytic agent** usually combined with another anticoagulant (such as oxalate or EDTA), used for **glucose measurement**, as it inhibits glycolysis and preserves glucose levels. - It is not appropriate for ESR testing, as it does not provide the optimal conditions for red blood cell sedimentation measurement.

Q: Name the inclusions shown in the blast.

Auer rods. ***Auer rods*** - The image clearly displays **rod-shaped cytoplasmic inclusions** within the blast cell, characteristic of **Auer rods**. - Auer rods are usually composed of fused **azurophilic granules** and establish myeloid lineage; they are most characteristic of **acute myeloid leukemia (AML)** but may also occur in other myeloid neoplasms. *Azurophilic granules* - While Auer rods are derived from azurophilic granules, the image shows distinct **rod-like structures**, not individual, small, round azurophilic granules. - Azurophilic granules are primary granules found in early myeloid cells, but they appear as **fine, dust-like particles** or small spheres, not large rods. *Dohle bodies* - **Dohle bodies** are pale blue-gray cytoplasmic inclusions usually found in **neutrophils** during infection or inflammation, representing aggregates of rough endoplasmic reticulum. - They appear as **oval or round structures** in the peripheral cytoplasm and do not resemble the rod-shaped inclusions seen in the blast. *Heinz bodies* - **Heinz bodies** are inclusions composed of **denatured hemoglobin** found within red blood cells, not white blood cells or blasts. - They are typically associated with **oxidative stress** or certain enzyme deficiencies in red blood cells. *Howell-Jolly bodies* - **Howell-Jolly bodies** are small, round nuclear remnants (DNA fragments) found in **red blood cells**, not in blast cells. - They appear as single or multiple dark purple-blue inclusions in RBCs and are seen in conditions like **asplenia** or **severe hemolytic anemia**.

Q: Name the test given.

ESR measurement. ***ESR measurement*** - The image displays a **Wintrobe tube** with a column of blood, showing distinct layers of plasma on top and red blood cells settled below against a calibrated scale. - This setup is characteristic of an **Erythrocyte Sedimentation Rate (ESR)** test (Wintrobe method), which measures the rate at which red blood cells fall in a standardized tube over a specific time, indicating inflammation. *Osmotic fragility* - This test involves exposing red blood cells to varying concentrations of **hypotonic saline solutions** to assess their resistance to lysis. - The results are typically reported as a curve showing the percentage of hemolysis at different saline concentrations, not a simple sedimentation in a tube. *NESTROFT* - The **Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT)** is a quick screening test for **beta-thalassemia trait**. - It involves mixing blood with a hypotonic saline solution and observing for complete hemolysis or partial hemolysis with a button of red cells, which is different from the image shown. *Sickling test* - A sickling test is used to detect the presence of **sickle hemoglobin**, which causes red blood cells to deform into a sickle shape under low oxygen conditions. - This test is usually performed by adding a reducing agent like **sodium metabisulfite** to a blood sample and observing cell morphology under a microscope or by turbidity, not by sedimentation in a calibrated tube. *Packed cell volume (PCV)* - PCV or **hematocrit** measures the proportion of blood volume occupied by red blood cells after centrifugation in a **microhematocrit tube**. - While it does involve blood in a tube, the tube is much smaller (capillary tube) and requires **centrifugation** to separate components, unlike ESR which relies on natural sedimentation under gravity in a larger calibrated tube.

Question 1

The image shows electrophoresis report of multiple myeloma. The spike is present in:

Accepted Answer

Gamma globulin

Answer

Alpha 1 globulin

Answer

Alpha 2 globulin

Answer

Beta globulin

Answer

Albumin

Question 2

A 7-year-old boy presents with swelling of cheek for 2 months. Biopsy from the lesions shows presence of:

Accepted Answer

Burkitt lymphoma

Answer

Mycosis fungoides

Answer

Langerhans cell histiocytosis

Answer

Hodgkin's lymphoma

Answer

Diffuse large B-cell lymphoma

Question 3

Which instrument is shown below?

Accepted Answer

Automated hematology analyzer

Answer

Pilocarpine iontophoresis

Answer

Flame Photometry

Answer

NESTROFT

Answer

Coagulation analyzer

Question 4

The following presentation can be seen in: Bone marrow biopsy shows >80% monocytic lineage cells (monoblasts and promonocytes), with immunophenotyping positive for CD14, CD64, and CD11b, and negative for significant myeloid (neutrophilic) precursor expansion.

Accepted Answer

Acute monocytic leukemia

Answer

Acute megakaryocytic leukemia

Answer

T cell acute lymphoblastic leukemia

Answer

B cell, acute lymphoblastic leukemia

Answer

Acute myelomonocytic leukemia

Question 5

The following electron microscopy picture is a cytoplasmic feature seen in:

Accepted Answer

Histiocytosis X

Answer

Plasmacytoma

Answer

Neuroblastoma

Answer

Chloroma

Answer

Gaucher disease

Question 6

The image shows:

Accepted Answer

Plasma cells

Answer

Langerhans cells

Answer

Reed Sternberg cells

Answer

CMV infected cells

Answer

Mast cells

Question 7

Name the anticoagulant used in the traditional diluted Westergren method shown below.

Accepted Answer

Trisodium citrate

Answer

EDTA

Answer

Heparin

Answer

Dalteparin

Answer

Sodium fluoride

Question 8

Name the inclusions shown in the blast.

Accepted Answer

Auer rods

Answer

Azurophilic granules

Answer

Dohle bodies

Answer

Heinz bodies

Answer

Howell-Jolly bodies

Question 9

A blood sample is placed in a single tube containing 0.36% buffered saline (hypotonic solution). The tube is observed against a black background line after 30 minutes. The tube appears turbid and the black line cannot be seen through it. This test is used as a screening tool for:

Accepted Answer

Thalassemia

Answer

Hereditary spherocytosis

Answer

G6PD

Answer

Megaloblastic anemia

Answer

Sickle cell disease

Question 10

Name the test given.

Accepted Answer

ESR measurement

Answer

Sickling test

Answer

NESTROFT

Answer

Osmotic fragility

Answer

Packed cell volume (PCV)

Hematopathology — MCQs

Hematopathology — MCQs

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