Hematopathology Practice Questions

Q: A couple, with a family history of beta thalassemia major in a distant relative, has come for counseling. The husband has HbA2 of 4.8% and the wife has HbA2 of 2.3%. What is the risk of them having a child with beta thalassemia major?

0%. ### Explanation The risk of a child having Beta Thalassemia Major depends on the carrier status of **both** parents. Beta thalassemia is an autosomal recessive disorder. **1. Why the correct answer is 0%:** * **The Husband:** An **HbA2 level >3.5%** (specifically 4%–8%) is the diagnostic hallmark of **Beta Thalassemia Trait (BTT)**. With an HbA2 of 4.8%, the husband is a carrier. * **The Wife:** A normal HbA2 level is typically **between 2% and 3%**. Her level of 2.3% is well within the normal range, indicating she is **not a carrier** of the beta-thalassemia gene. * **The Inheritance:** For a child to have Thalassemia Major, they must inherit one mutated gene from *each* parent (Homozygous state). Since the wife is hematologically normal, she will always pass on a normal gene. Therefore, the couple can only have children who are either normal or carriers (Thalassemia Minor), but the risk of Thalassemia Major is **0%**. **2. Why the incorrect options are wrong:** * **25%:** This would be the risk if **both** parents were carriers (BTT x BTT). * **50%:** This would be the risk of having a child with **Thalassemia Minor** (carrier) in this specific scenario, or the risk of Major if one parent had Thalassemia Intermedia/Major and the other was a carrier. * **5%:** This value does not correspond to standard Mendelian inheritance patterns for this condition. **3. Clinical Pearls for NEET-PG:** * **Screening Gold Standard:** Hb-HPLC (High-Performance Liquid Chromatography) is used to quantify HbA2. * **Mentzer Index:** (MCV/RBC count) 13 suggests Iron Deficiency Anemia. * **Silent Carriers:** If a patient has microcytic anemia but normal HbA2, consider **Alpha Thalassemia** or co-existing Iron Deficiency (which can falsely lower HbA2). * **Rule of Thumb:** If one parent is normal, Thalassemia Major is impossible in the offspring.

Q: Megaloblastic anemia may be caused by all of the following except?

Long term aspirin intake. Megaloblastic anemia is characterized by impaired DNA synthesis, leading to the presence of large, nucleated red blood cell precursors (megaloblasts) in the bone marrow [1]. **Why Long-term Aspirin is the Correct Answer:** Aspirin (Acetylsalicylic acid) is a non-steroidal anti-inflammatory drug (NSAID) that inhibits cyclooxygenase (COX) enzymes. While chronic aspirin use is associated with **Iron Deficiency Anemia** (due to occult gastrointestinal bleeding), it does not interfere with DNA synthesis or folate/B12 metabolism. Therefore, it does not cause megaloblastic anemia. **Analysis of Incorrect Options:** * **Vitamin B12 & Folic Acid Deficiency:** These are the most common causes [3]. B12 and Folate are essential co-factors for DNA synthesis [2]. Deficiency leads to "nuclear-cytoplasmic asynchrony," where the nucleus matures slower than the cytoplasm. * **Dilantin (Phenytoin) Toxicity:** Phenytoin is a notorious cause of drug-induced megaloblastic anemia. It interferes with folate metabolism by inhibiting the intestinal enzyme (folate conjugase) required for folate absorption and by increasing folate catabolism. **NEET-PG High-Yield Pearls:** * **Drug-Induced Megaloblastic Anemia (Mnemonic: "M-P-S-T"):** * **M**ethotrexate (Dihydrofolate reductase inhibitor) * **P**henytoin/Pyrimethamine * **S**ulfa drugs (Trimethoprim) * **T**rimethoprim * **Zidovudine (AZT):** A common cause of macrocytosis (increased MCV) without necessarily causing full megaloblastic changes. * **Nitrous Oxide:** Can cause acute megaloblastic anemia by oxidizing the cobalt atom in Vitamin B12, rendering it inactive.

Question 1

Which of the following statements is true of hereditary spherocytosis (HS)?

Accepted Answer

Pigment-type gallstones are common.

Answer

Diagnosis can be made in the neonatal period easily by examination of a blood film.

Answer

Intravascular hemolysis is a common feature.

Answer

Autosomal recessive inheritance is seen in the majority of cases.

Question 2

Antibodies in Immune Thrombocytopenic Purpura (ITP) are typically:

Accepted Answer

IgG

Answer

IgM

Answer

IgE

Answer

IgD

Question 3

A couple, with a family history of beta thalassemia major in a distant relative, has come for counseling. The husband has HbA2 of 4.8% and the wife has HbA2 of 2.3%. What is the risk of them having a child with beta thalassemia major?

Accepted Answer

0%

Answer

50%

Answer

25%

Answer

5%

Question 4

Which of the following is NOT an intrinsic cause of hemolytic anemia?

Accepted Answer

Hypersplenism

Answer

G6PD deficiency

Answer

Hereditary spherocytosis

Answer

Pyruvate kinase deficiency

Question 5

All of the following are major complications of massive blood transfusion except?

Accepted Answer

Hyperthermia

Answer

Hyperkalemia

Answer

Coagulopathy

Answer

Hypocalcemia

Question 6

Howell-Jolly bodies may be seen after which procedure?

Accepted Answer

Splenectomy

Answer

Hepatectomy

Answer

Pancreatectomy

Answer

Cholecystectomy

Question 7

Thymic hyperplasia is seen in which condition?

Accepted Answer

Myasthenia gravis

Answer

Thymoma

Answer

Thymic lymphoma

Answer

Scleroderma

Question 8

Megaloblastic anemia may be caused by all of the following except?

Accepted Answer

Long term aspirin intake

Answer

Dilantin toxicity

Answer

Vitamin B12 deficiency

Answer

Folic acid deficiency

Question 9

Which of the following is NOT a cause of pancytopenia with hypocellular marrow?

Accepted Answer

Aleukemic leukemia

Answer

Acquired aplastic anemia

Answer

Fanconi's anaemia

Answer

Some myelodysplasia

Question 10

All of the following acute myeloid leukemias are diagnosed regardless of blast count, except?

Accepted Answer

AML with t(1;9)

Answer

AML with t(8;21)

Answer

AML with t(15;17)

Answer

AML with t(16;16)

Hematopathology — MCQs

Hematopathology — MCQs

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