Hematopathology Practice Questions

Q: Which stain is used for the diagnosis of granulocytic sarcoma?

Myeloperoxidase. **Explanation:** **Granulocytic Sarcoma** (also known as **Chloroma** or Myeloid Sarcoma) is an extramedullary tumor mass composed of immature myeloid cells. It is most commonly associated with Acute Myeloid Leukemia (AML), particularly the M2, M4, and M5 subtypes. **Why Myeloperoxidase (MPO) is the correct answer:** MPO is the most sensitive and specific marker for cells of the **myeloid lineage**. Since granulocytic sarcoma consists of myeloblasts and maturing granulocytes, MPO staining (either via cytochemistry or immunohistochemistry) is the gold standard for confirming the myeloid nature of the tumor cells and differentiating it from lymphomas. **Analysis of Incorrect Options:** * **Leucocyte Alkaline Phosphatase (LAP):** This enzyme is found in mature neutrophils. The LAP score is used to differentiate Leukemoid Reaction (High score) from Chronic Myeloid Leukemia (Low score). It is not used to identify immature blasts in a sarcoma. * **Non-specific Esterase (NSE):** This stain is a marker for the **monocytic lineage**. While it may be positive in the myelomonocytic variant of myeloid sarcoma, MPO remains the primary diagnostic stain for the "granulocytic" type. * **Neuron Specific Enolase (NSE):** This is a marker for neuroendocrine tumors and small cell carcinomas, having no role in the diagnosis of myeloid neoplasms. **High-Yield Clinical Pearls for NEET-PG:** * **Common Site:** Often involves the bone, periosteum, soft tissues, and lymph nodes. * **Cytogenetics:** Frequently associated with **t(8;21)** [1]. * **Nomenclature:** The term "Chloroma" is derived from the greenish color of the tumor caused by the presence of the MPO enzyme itself. * **Other Markers:** CD33, CD117 (c-kit), and Lysozyme are also typically positive. **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.

Q: A 40-year-old female patient presents with excessive bleeding following a road traffic accident 5 hours prior, with a lacerated wound on the lower back. Blood grouping tests reveal the presence of Anti-A antibody, Anti-B antibody, Anti-H antibody, and Anti-Rh D antibody in her serum. What is the blood group of this patient?

Bombay blood group. **Explanation:** The correct answer is **Bombay blood group (Oh phenotype)**. **1. Why the Bombay blood group is correct:** The key to this question lies in the presence of **Anti-H antibodies**. In the ABO biosynthetic pathway, the **H substance** (formed by the action of fucosyltransferase on a precursor chain) is the essential substrate upon which A and B antigens are built. * Individuals with the **Bombay phenotype (hh)** lack the *H gene*; therefore, they cannot produce H substance. * Because they lack H substance, they cannot produce A or B antigens, even if they possess the A or B genes. * Consequently, their serum contains naturally occurring, potent, high-titer **Anti-A, Anti-B, and Anti-H antibodies** [1]. Since the patient also has Anti-Rh D, she is Rh-negative. **2. Why the other options are incorrect:** * **O Positive/Negative:** Individuals with blood group O possess the **H antigen** (in fact, they have the highest concentration of H substance). Therefore, they **do not** produce Anti-H antibodies. * **AB Positive:** These individuals have A, B, and H antigens on their RBCs; their serum contains no antibodies against these antigens [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **Discovery:** First described by Bhende in Mumbai (1952). * **Genotype:** *hh* (autosomal recessive inheritance). * **Testing Pitfall:** On routine forward grouping, Bombay blood group mimics **Group O** because it lacks A and B antigens. It is only identified during **reverse grouping** (cross-matching) because it reacts with O-group cells (due to Anti-H). * **Transfusion:** Patients can **only** receive blood from another Bombay phenotype individual. * **Secretor Status:** They are always non-secretors. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628.

Q: Reticulocytes are stained by which of the following dyes?

Brilliant cresyl blue. **Explanation:** Reticulocytes are immature red blood cells that contain residual ribosomal RNA (rRNA). Because these cells lack a nucleus but still possess organelles, they cannot be identified using routine Romanowsky stains (like Leishman or Giemsa), which only show them as slightly larger, bluish cells (polychromasia). **1. Why Brilliant Cresyl Blue is correct:** To visualize the network of rRNA (the "reticulum"), **supravital staining** is required. This involves staining living cells before they are fixed. **Brilliant cresyl blue** (or New Methylene Blue) is a basic dye that reacts with the acidic rRNA, causing it to precipitate into a visible blue, granular filament or network. This allows for an accurate reticulocyte count, which is a key indicator of bone marrow erythropoietic activity. **2. Analysis of Incorrect Options:** * **Methyl violet:** Primarily used as a histological stain and for staining **Heinz bodies** (denatured hemoglobin) in G6PD deficiency [1]. * **Sudan black:** A lipid-soluble dye used to stain neutral triglycerides and lipids. In hematology, it is used to differentiate **Acute Myeloid Leukemia (AML)** from ALL by staining myeloblasts. * **Indigo carmine:** A dye used primarily in surgery and urology to highlight the urinary tract or to detect amniotic fluid leaks; it is not used for blood cell morphology. **Clinical Pearls for NEET-PG:** * **Supravital Stains:** Remember the mnemonic **"RNB"** (Reticulocytes, New Methylene Blue, Brilliant Cresyl Blue). * **Reticulocyte Count:** It is the best indicator of **effective erythropoiesis**. A high count is seen in hemolytic anemias, while a low count suggests bone marrow failure (e.g., Aplastic anemia). * **Heinz Bodies:** These also require supravital stains (like Crystal Violet) but appear as single coccoid granules at the cell periphery, unlike the network seen in reticulocytes [1].

Q: EBV positivity is higher in which type of Hodgkin lymphoma?

Mixed cellularity. **Explanation:** The association between **Epstein-Barr Virus (EBV)** and Hodgkin Lymphoma (HL) varies significantly across histological subtypes. EBV is found in the Reed-Sternberg (RS) cells, where it expresses LMP-1 (Latent Membrane Protein-1), mimicking CD40 signaling to promote B-cell survival. * **Mixed Cellularity (MC):** This subtype shows the strongest association with EBV in classical HL, with **75% to 85%** of cases being EBV-positive. It typically affects older patients or those in developing countries and is characterized by a polymorphic inflammatory infiltrate (eosinophils, plasma cells, histiocytes) [1]. * **Lymphocyte Depleted (LD):** This also has a very high association with EBV (approx. 90%), but it is the rarest subtype. In the context of standard NEET-PG questions, **Mixed Cellularity** is the classic answer for "highest association" among the common subtypes [1]. * **Nodular Sclerosis (NS):** This is the most common subtype overall (especially in young females). It has a relatively low EBV association (approx. 10-40%) [1]. * **Lymphocyte Rich (LR):** This subtype has an intermediate association (approx. 40%) and carries a very good prognosis [1]. * **Nodular Lymphocyte Predominant HL (NLPHL):** This is a non-classical HL and is almost **always EBV-negative**. **High-Yield Pearls for NEET-PG:** 1. **Most common subtype:** Nodular Sclerosis (characterized by Lacunar cells and collagen bands) [1]. 2. **Best prognosis:** Lymphocyte Rich (among classical) or NLPHL. 3. **Worst prognosis:** Lymphocyte Depleted. 4. **RS Cell Markers:** Classical HL is **CD15+, CD30+, and CD45–**. NLPHL is **CD20+ and CD45+** (Popcorn 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. 616-618.

Question 1

Which marker is used to assess monoclonality in T-cells?

Accepted Answer

TCR gene rearrangement

Answer

Kappa and Lambda chain

Answer

CD

Answer

CD34

Question 2

Which stain is used for the diagnosis of granulocytic sarcoma?

Accepted Answer

Myeloperoxidase

Answer

Leucocyte alkaline phosphatase

Answer

Non specific esterase

Answer

Neuron specific esterase

Question 3

Basophilic stippling of red blood cells is a finding associated with which of the following enzymatic deficiencies?

Accepted Answer

5' nucleotidase deficiency

Answer

ALA synthetase deficiency

Answer

Ferrochelatase deficiency

Answer

ALA dehydrogenase deficiency

Question 4

A 40-year-old female patient presents with excessive bleeding following a road traffic accident 5 hours prior, with a lacerated wound on the lower back. Blood grouping tests reveal the presence of Anti-A antibody, Anti-B antibody, Anti-H antibody, and Anti-Rh D antibody in her serum. What is the blood group of this patient?

Accepted Answer

Bombay blood group

Answer

O positive

Answer

O negative

Answer

AB positive

Question 5

Which of the following conditions typically shows an elevated Erythrocyte Sedimentation Rate (ESR)?

Accepted Answer

Multiple myeloma and Acute myocardial infarction

Answer

Multiple myeloma

Answer

Sickle cell anemia and Multiple myeloma

Answer

Sickle cell anemia and Angina pectoris

Question 6

Bone marrow biopsy is useful in the diagnosis of which of the following conditions?

Accepted Answer

Aleukemic Leukemia

Answer

Chronic Myeloid Leukemia (CML)

Answer

Acute Lymphoblastic Leukemia (ALL)

Answer

Hodgkin's disease

Question 7

Reticulocytes are stained by which of the following dyes?

Accepted Answer

Brilliant cresyl blue

Answer

Methyl violet

Answer

Sudan black

Answer

Indigo carmine

Question 8

EBV positivity is higher in which type of Hodgkin lymphoma?

Accepted Answer

Mixed cellularity

Answer

Nodular sclerosis

Answer

Lymphocyte depleted

Answer

Lymphocyte rich

Question 9

Primary hemostasis is disturbed in which of the following conditions?

Accepted Answer

Platelet disorder

Answer

Lupus anticoagulant

Answer

Hemophilia

Answer

Liver disease

Question 10

Spherocytosis of RBC is a common feature in which of the following conditions?

Accepted Answer

G6PD deficiency

Answer

Sickle cell anemia

Answer

CML

Answer

All of the above

Hematopathology — MCQs

Hematopathology — MCQs

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