Hematopathology Practice Questions

Q: Platelets can be stored at what temperature and for how long?

20-24°C for 5 days. **Explanation:** The correct answer is **A. 20-24°C for 5 days.** **Underlying Medical Concept:** Platelets are unique among blood components because they must be stored at **room temperature (20-24°C)** with **continuous agitation**. Agitation (via a platelet agitator) is crucial to prevent platelet aggregation and to facilitate gas exchange, maintaining a pH above 6.0. If platelets are refrigerated (4-8°C), they undergo "cold-induced activation" and structural changes (becoming spherical), leading to rapid clearance by the recipient's spleen after transfusion. The 5-day limit is strictly enforced primarily due to the **risk of bacterial proliferation**, which is higher at room temperature compared to refrigerated components. **Analysis of Incorrect Options:** * **B & D (8 days):** Extending storage to 8 days significantly increases the risk of life-threatening bacterial sepsis. While some newer technologies (like pathogen reduction or large-volume delayed sampling) can extend shelf life to 7 days, the standard board-exam answer remains 5 days. * **C & D (4-8°C):** This is the storage temperature for **Whole Blood and Packed Red Blood Cells (PRBCs)**. Refrigeration preserves red cell metabolic activity but renders platelets non-functional for transfusion purposes. **High-Yield Clinical Pearls for NEET-PG:** * **Agitation:** Essential to prevent lactic acidosis and maintain platelet viability. * **Bacterial Sepsis:** Platelets are the blood component most commonly associated with transfusion-transmitted bacterial infections (most common: *Staphylococcus epidermidis*). * **Dose:** One unit of Random Donor Platelets (RDP) typically increases the count by 5,000–10,000/µL, whereas one unit of Single Donor Platelets (SDP) increases it by 30,000–60,000/µL. * **Fresh Frozen Plasma (FFP):** Stored at **-18°C or colder** for up to 1 year.

Q: A 50-year-old male presented with left upper quadrant pain. On examination, the spleen was palpable 10 cm below the left costal margin. A peripheral smear is shown. Which of the following immunohistochemical markers is used for the diagnosis of the condition?

Annexin A1. ***Annexin A1*** - **Annexin A1** is the specific immunohistochemical marker for **hairy cell leukemia (HCL)**, which presents with massive splenomegaly and characteristic "hairy cells" on peripheral smear. - It helps distinguish **classic HCL** from **HCL-variant** and other B-cell lymphomas, making it the diagnostic marker of choice. *CD23* - **CD23** is primarily used as a marker for **chronic lymphocytic leukemia (CLL)** and **small lymphocytic lymphoma**. - CLL typically presents with **lymphadenopathy** rather than massive splenomegaly, and lacks the characteristic hairy cell morphology. *CD21* - **CD21** is a marker for **B-cells** and **follicular dendritic cells**, but is not specific for any particular lymphoid malignancy. - It does not help differentiate **hairy cell leukemia** from other B-cell disorders and lacks diagnostic specificity. *Cyclin D1* - **Cyclin D1** is the characteristic marker for **mantle cell lymphoma**, which has a different clinical presentation and morphology. - Mantle cell lymphoma typically affects **elderly males** with lymphadenopathy and **gastrointestinal involvement**, not isolated massive splenomegaly.

Q: A 10-year-old male child presents with pallor and a history of blood transfusion 2 months back. On investigation, Hb is 4.5 gms, total count is 60,000, and platelet count is 2 lakhs. Immunophenotyping shows CD10+, CD19+, CD117+, MPO+, and CD33-. What is the most probable diagnosis?

Mixed phenotypic acute leukemia. **Explanation:** The diagnosis of **Mixed Phenotypic Acute Leukemia (MPAL)** is based on the presence of markers from two different lineages on the same blast population (biphenotypic) or two distinct populations of blasts (bilineal). In this case, the immunophenotype shows a combination of: * **B-cell lineage markers:** CD10 and CD19 [1]. * **Myeloid lineage markers:** MPO (the most specific marker for myeloid differentiation) and CD117. According to the WHO classification, the expression of **MPO** (via flow cytometry or immunohistochemistry) is sufficient to assign a myeloid lineage, while **CD19** (strong) along with other B-markers like **CD10** confirms B-lineage involvement. Since both criteria are met, it is classified as MPAL. **Analysis of Incorrect Options:** * **A. Acute Lymphoblastic Leukemia (ALL):** While CD10 and CD19 are classic B-ALL markers, the presence of MPO and CD117 rules out a pure lymphoid diagnosis [1]. * **B. Acute Myeloid Leukemia (AML):** Although MPO and CD117 are myeloid markers, the strong expression of B-cell markers (CD10, CD19) precludes a diagnosis of pure AML. * **C. Undifferentiated Leukemia:** This diagnosis is reserved for cases where blasts lack any lineage-specific markers (negative for MPO, T-cell, and B-cell markers). **Clinical Pearls for NEET-PG:** * **MPO** is the "gold standard" for myeloid lineage. * For **B-lineage** assignment in MPAL: Strong CD19 + one other B-marker (CD10, CD22, or CD79a) is required. * For **T-lineage** assignment: Cytoplasmic CD3 is the most specific marker. * MPAL generally carries a **poorer prognosis** compared to lineage-specific acute leukemias and often requires more intensive, hybrid chemotherapy protocols. **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. 599-600.

Q: Which organ is most commonly affected in the disorder characterized by the given peripheral blood smear findings?

Spleen. ***Spleen*** - The spleen is the **most commonly affected organ** in sickle cell disease due to **vaso-occlusive crises** causing repeated infarction and congestion. - Early in the disease, the spleen undergoes **sequestration crises**, and later develops **autosplenectomy** from repeated sickling episodes. *Lungs* - While **acute chest syndrome** can occur in sickle cell disease, it is not the most commonly affected organ overall. - Pulmonary complications are **episodic** rather than the primary site of chronic organ damage. *Kidney* - **Nephropathy** can develop in sickle cell disease due to chronic hypoxia and sickling in renal medulla. - However, renal involvement typically occurs **later in the disease course** and is less frequent than splenic complications. *Liver* - **Hepatic sequestration** and cholestasis can occur but are **less common** than splenic involvement. - Liver complications are usually **secondary** to hemolysis and transfusion-related iron overload rather than primary sickling effects.

Question 1

Microangiopathic hemolytic anemia (MAHA) is a component of all of the following, except?

Accepted Answer

Paroxysmal nocturnal hemoglobinuria

Answer

Thrombotic thrombocytopenic purpura (TTP)

Answer

Hemolytic uremic syndrome (HUS)

Answer

Hemolysis with elevated liver enzymes and low platelet (HELLP) syndrome

Question 2

Bence Jones proteinuria is found on a urinalysis specimen from a 63-year-old woman who is developing chronic renal failure with high serum urea nitrogen and creatinine. A radiograph of the vertebral column demonstrates multiple 1 to 2 cm rounded areas of decreased bone density. The pathological examination from a renal biopsy is likely to show which of the following complications?

Accepted Answer

Amyloidosis

Answer

Pneumocystis carinii pneumonia

Answer

Sclerodactyly

Answer

Chronic myelogenous leukemia

Question 3

A patient presents with a lytic bone lesion. Histology reveals monoclonal plasma cells. Bone marrow biopsy shows less than 10 percent plasma cells, and a small M spike is reported on electrophoresis. Skeletal survey is otherwise unremarkable. What is the most likely diagnosis?

Accepted Answer

Plasmacytoma

Answer

Multiple Myeloma

Answer

Smoldering Myeloma

Answer

Lymphoma

Question 4

Platelets can be stored at what temperature and for how long?

Accepted Answer

20-24°C for 5 days

Answer

20-24°C for 8 days

Answer

4-8°C for 5 days

Answer

4-8°C for 8 days

Question 5

A 50-year-old male presented with left upper quadrant pain. On examination, the spleen was palpable 10 cm below the left costal margin. A peripheral smear is shown. Which of the following immunohistochemical markers is used for the diagnosis of the condition?

Accepted Answer

Annexin A1

Answer

CD23

Answer

CD21

Answer

Cyclin D1

Question 6

Paroxysmal nocturnal hemoglobinuria (PNH) is a disease that results from defects in which of the following?

Accepted Answer

GPI (Glycosylphosphatidylinositol)

Answer

Ankyrin

Answer

Band 3

Answer

Spectrin

Question 7

A 10-year-old male child presents with pallor and a history of blood transfusion 2 months back. On investigation, Hb is 4.5 gms, total count is 60,000, and platelet count is 2 lakhs. Immunophenotyping shows CD10+, CD19+, CD117+, MPO+, and CD33-. What is the most probable diagnosis?

Accepted Answer

Mixed phenotypic acute leukemia

Answer

Acute lymphoblastic leukemia (ALL)

Answer

Acute myeloid leukemia (AML)

Answer

Undifferentiated leukemia

Question 8

An 80-year-old asymptomatic woman on routine examination was detected to have a monoclonal spike on serum electrophoresis (IgG levels 1.5 g/dl). Bone marrow revealed 8% plasma cells. Which of the following represents the most likely diagnosis?

Accepted Answer

Monoclonal gammopathy of unknown significance

Answer

Multiple myeloma

Answer

Indolent myeloma

Answer

Waldenstrom's macroglobulinemia

Question 9

Which of the following conditions predisposes to leukemia?

Accepted Answer

Infectious mononucleosis

Answer

Ionizing radiation

Answer

Myelofibrosis

Answer

Polycythemia vera

Question 10

Which organ is most commonly affected in the disorder characterized by the given peripheral blood smear findings?

Accepted Answer

Spleen

Answer

Lungs

Answer

Kidney

Answer

Liver

Hematopathology — MCQs

Hematopathology — MCQs

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