Hematopathology — MCQs

Q: Hemoglobin electrophoresis in a 5-year-old anemic patient shows HbF=90 % and HbA2=3 %. Select the correct combination of findings of peripheral smear from the ones shown below.

A, C. ***HbF=90 % and HbA2=3 %*** - The high HbF (90%) and normal HbA2 (3%) in a 5-year-old anemic patient are characteristic findings of **beta-thalassemia major** [1]. - In **beta-thalassemia major**, the severe deficiency or absence of beta-globin chains leads to ineffective erythropoiesis and severe anemia, compensated by persistent high HbF production [1]. *HbF=90 % and HbA2=5 %* - While high HbF is seen in beta-thalassemia major, an HbA2 level of 5% is **elevated**, which is typically seen in **beta-thalassemia trait** or **intermedia**, not the severe major form where HbA2 is usually normal or slightly elevated [1]. - This combination would suggest a less severe form of thalassemia or a different hemoglobinopathy. *HbF=5 % and HbA2=3 %* - HbF at 5% is within the **normal range for an adult**, but too low for a 5-year-old with a significant hemoglobinopathy like beta-thalassemia major [1]. - This combination does not explain the patient's anemia in the context of a severe thalassemia. *HbF=5 % and HbA2=5 %* - Both HbF at 5% and HbA2 at 5% are **not consistent** with beta-thalassemia major in a 5-year-old [1]. - An HbF of 5% is too low for beta-thalassemia major, and an HbA2 of 5% is elevated, suggesting a trait rather than a severe form. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 646-648.

Q: Which of the following hematological condition is shown below?

Megaloblastic anemia. ***Megaloblastic anemia*** - The image likely displays **hypersegmented neutrophils** and **macrocytic red blood cells**, which are characteristic features of **megaloblastic anemia** [1]. - This condition results from impaired DNA synthesis, often due to **vitamin B12** or **folate deficiency**. *Multiple myeloma* - This condition is characterized by the proliferation of **plasma cells** in the bone marrow, leading to **rouleaux formation** of red blood cells and **punched-out lesions** in bones [2]. - While rouleaux can be seen, the primary features of megaloblastic anemia (hypersegmented neutrophils, macro-ovalocytes) are distinct. *CML* - **Chronic Myeloid Leukemia (CML)** is a myeloproliferative neoplasm characterized by the presence of the **Philadelphia chromosome** (BCR-ABL fusion gene) [3]. - Peripheral blood smears typically show a **leukocytosis** with a full spectrum of myeloid maturation, including increased **basophils** and **eosinophils**, which are not the defining features of the image. *Metastasis* - **Metastasis** refers to the spread of cancer cells from a primary tumor to distant sites, often involving the bone marrow. - While bone marrow involvement can lead to various hematological abnormalities, the specific features of **hypersegmented neutrophils** and **macrocytic red blood cells** are not directly indicative of metastasis but rather of a primary hematological disorder like megaloblastic anemia. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614. [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. 606-607. [3] 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. 624-625.

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Red blood cell disorders

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Platelet disorders

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Coagulation disorders

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Acute leukemias

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Chronic leukemias

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Myeloproliferative neoplasms

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Myelodysplastic syndromes

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Hodgkin lymphoma

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Non-Hodgkin lymphomas

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Plasma cell disorders

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Bone marrow failure syndromes

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Splenic pathology

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