Hematopathology Practice Questions

Q: Which blood is transfused in a patient with a Bombay blood group?

Bombay (Oh) blood. ***Bombay (Oh) blood*** - Patients with Bombay phenotype lack the **H antigen** due to deficiency of **fucosyltransferase enzyme** and can only receive Bombay (Oh) blood safely. - They produce potent **anti-H, anti-A, and anti-B antibodies**, making them compatible only with other Bombay donors who also lack the H antigen. *A* - Contains both **A antigen and H antigen**, causing severe hemolytic transfusion reaction due to anti-A and anti-H antibodies. - The presence of **H antigen** makes it completely incompatible with Bombay phenotype patients. *B* - Contains both **B antigen and H antigen**, leading to rapid hemolysis from anti-B and anti-H antibodies. - Like all standard ABO blood types, the **H antigen presence** makes transfusion dangerous and contraindicated. *AB* - Contains **A antigen, B antigen, and H antigen**, causing the most severe hemolytic reaction from all three antibodies. - This is the most incompatible blood type for Bombay patients due to multiple antigen incompatibilities. *O negative* - Though lacking A and B antigens, **O negative still contains the H antigen** present in all standard ABO blood groups. - Transfusing O negative to Bombay patients causes **severe acute hemolytic transfusion reaction** due to anti-H antibodies, making it unsafe despite being the universal donor for standard ABO types.

Q: What type of cell is shown in the image below?

Reed Sternberg cell. ***Reed Sternberg cell*** - This is a classic **Reed-Sternberg cell**, characterized by its large size, bilobed or multinucleated appearance, and prominent eosinophilic nucleoli, which create a pathognomonic "**owl-eye**" look [1], [2]. - These cells are the neoplastic hallmark of **Hodgkin lymphoma** and are crucial for its diagnosis [2]. *Faggot cell* - Faggot cells are malignant promyelocytes containing numerous **Auer rods** that are bundled together, resembling a bundle of sticks. - They are characteristically seen in **Acute Promyelocytic Leukemia (APL)**, a subtype of AML, and are not depicted in the image. *Mott cells* - Mott cells are plasma cells with cytoplasm packed with **Russell bodies**, which are eosinophilic globules of immunoglobulin, giving the cell a "grape-like" appearance. - They are found in conditions with chronic plasma cell stimulation or plasma cell neoplasms like **multiple myeloma**, but their morphology is distinct from the cell shown. *Sézary-Lutzner cells* - These are malignant T-lymphocytes characterized by a highly convoluted, **cerebriform (brain-like) nucleus**. - They are the hallmark cells of cutaneous T-cell lymphomas, such as **Mycosis Fungoides** and **Sézary syndrome**, and lack the "owl-eye" nucleoli seen in the image. **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. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 556-557.

Q: Which of the following is a feature of hemolytic anemia?

Decreased haptoglobin. ***Decreased haptoglobin***- Hemolytic anemia involves the rapid breakdown of red blood cells, which releases **free hemoglobin** into the blood plasma. [1]- **Haptoglobin** rapidly binds to this free hemoglobin and is subsequently cleared by the **reticuloendothelial system**, leading to significantly reduced or absent plasma haptoglobin levels. [1]*All of the options given below*- This option is incorrect because both **neutropenia** and **reticulocytopenia** are generally *not* features of uncomplicated hemolytic anemia.*Neutropenia*- **Neutropenia** (low neutrophil count) is not typically associated with hemolytic anemia, which primarily affects the **red cell line**.- It is usually seen in conditions involving bone marrow failure (e.g., **aplastic anemia**) or destruction of white cells, not premature RBC destruction.*Reticulocytopenia*- Uncomplicated hemolytic anemia stimulates the bone marrow to produce new RBCs, resulting in **reticulocytosis** (increased reticulocytes) as a compensatory mechanism. [1]- **Reticulocytopenia** (low reticulocytes) is seen when the bone marrow cannot respond, such as during an **aplastic crisis** (often due to **Parvovirus B19** infection) or when the anemia is caused by true bone marrow failure. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 638-640.

Q: Which of the following is the most common chromosomal abnormality associated with acute myeloid leukemia (AML) with a favorable prognosis?

t(15;17) - PML-RARA fusion. ***t(15;17)*** - This translocation defines **Acute Promyelocytic Leukemia (APL)**, a distinct and highly curable subtype of AML, making its prognosis the most favorable [1]. - It results in the expression of the chimeric **PML/RARA fusion gene**, which is highly sensitive to differentiation agents like **all-trans retinoic acid (ATRA)**, leading to high cure rates [1]. *t(8;21) and inv(16) are also associated with a favorable prognosis, but t(15;17) often has the best outcome* - The **t(8;21)** and **inv(16)**/t(16;16) are classified as favorable or core-binding factor (CBF) AMLs, indicating good responsiveness to chemotherapy [1]. - Prognosis for CBF AML is superior to intermediate-risk AML, but generally not as excellent as APL treated with ATRA and arsenic. *Monosomy 7 (-7)* - The loss of chromosome 7 is a hallmark chromosomal abnormality associated with the **adverse risk** group in AML, indicating a significantly poor prognosis. - It is frequently observed in patients with pre-existing **Myelodysplastic Syndrome (MDS)** or **therapy-related AML (t-AML)**. *t(9;22)* - While this translocation is famous for defining **Chronic Myeloid Leukemia (CML)** (leading to the **BCR-ABL1** fusion gene), its presence in AML is generally associated with a complex karyotype or mixed-phenotype acute leukemia. - Its presence in AML usually confers a less favorable or **adverse prognosis**, unlike the highly favorable t(15;17). **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. 620-621.

Q: A lymphoma characterized by the presence of centrocytes and centroblasts, along with BCL2 positivity and CD10 expression, is most commonly associated with which chromosomal translocation?

t(14 ; 18). ***t(14 ; 18)*** [1], [2] - This translocation is the genetic hallmark of **Follicular Lymphoma (FL)**, characterized by the presence of **centrocytes** and **centroblasts**, **BCL2 positivity**, and **CD10 expression** [1], [2]. - It results in the juxtaposition of the **BCL2 gene** (on chromosome 18) with the **IgH locus** (on chromosome 14), leading to constitutive overexpression of the anti-apoptotic BCL2 protein [1], [2]. *t(2 ; 5)* - This translocation is characteristic of **Anaplastic Large Cell Lymphoma (ALCL)**, leading to the activation of the **ALK gene**. - ALCL is typically **CD30 positive** and lacks the centrocytes/centroblasts morphology and germinal center markers (like CD10) seen in the described B-cell lymphoma. *t(11 ; 14)* - This translocation is associated with **Mantle Cell Lymphoma (MCL)**, causing the overexpression of **Cyclin D1**. - While MCL cells are often BCL2 positive, they typically lack **CD10 expression**, which is a key feature of the described germinal center lymphoma. *t(8 ; 14)* - This translocation is the hallmark of **Burkitt Lymphoma**, resulting in **MYC gene** overexpression. - Burkitt Lymphoma is typically **CD10 positive** but shows a high proliferation index (Ki-67 ~100%) and lacks BCL2 expression [3], unlike the described follicular lymphoma. **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. 602-604. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 561-562. [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, p. 606.

Q: The following image shows:

Jamshidi needle. ***Jamshidi needle*** - The image displays a needle with a **tapered, open-ended tip** and a stylet, characteristic features of a Jamshidi needle, which is used for **bone marrow biopsy**. - The **winged hub** provides a secure grip and improved control during insertion and rotation. *Epidural needle* - An epidural needle typically has a **blunt, curved (Tuohy) tip** designed to push aside tissues and reduce the risk of puncturing the dura mater. - The tip shown in the image is sharp and tapered, not blunt or curved. *Pleural biopsy needle* - Pleural biopsy needles (e.g., Abrams needle) often have a **cutting mechanism** or a special design to obtain a tissue sample from the pleura, which is not evident in this image. - While some biopsy needles can be long, their tips are specifically adapted for cutting or grasping pleural tissue. *Quincke's needle* - A Quincke's needle is a type of spinal needle characterized by a **sharp, beveled tip** with an opening on the side, used for lumbar punctures to access cerebrospinal fluid. - The needle in the image has a different tip design, primarily for coring tissue, not for aspiration of fluid through a side port.

Question 1

Which blood is transfused in a patient with a Bombay blood group?

Accepted Answer

Bombay (Oh) blood

Answer

A

Answer

O negative

Answer

AB

Answer

B

Question 2

What type of cell is shown in the image below?

Accepted Answer

Reed Sternberg cell

Answer

Mott cells

Answer

Faggot cell

Answer

Sézary-Lutzner cells

Question 3

The following picture shows a lymph node biopsy of a 30-year-old male with cervical lymphadenopathy. The diagnosis is

Accepted Answer

Hodgkin disease

Answer

Chronic lymphocytic leukemia (CLL)

Answer

Human papillomavirus (HPV)

Answer

Acute myeloid leukemia (AML)

Question 4

A 70-year-old male comes with complaints of hip pain. An X-ray of the hip shows lytic lesions and elevated serum calcium levels. Bone marrow plasma cells are 42%, and the cells seen are given in the image below. What is the most likely diagnosis? ![img-31.jpeg](img-31.jpeg)

Accepted Answer

Multiple myeloma

Answer

ALL

Answer

CML

Answer

CLL

Question 5

Which of the following is a feature of hemolytic anemia?

Accepted Answer

Decreased haptoglobin

Answer

Neutropenia

Answer

Reticulocytopenia

Answer

All of the above

Question 6

Which of the following is the most common chromosomal abnormality associated with acute myeloid leukemia (AML) with a favorable prognosis?

Accepted Answer

t(15;17) - PML-RARA fusion

Answer

t(8;21) - RUNX1-RUNX1T1 fusion

Answer

t(9;22) - BCR-ABL fusion

Answer

Trisomy 21

Question 7

A 68-year-old man presents with bleeding manifestations. Peripheral smear shows the presence of cells shown below. Which of the following is the most common chromosomal abnormality seen in this condition?

Accepted Answer

t(15 ; 17)

Answer

t(14 ; 18)

Answer

inv(16)

Answer

t(8 ; 21)

Question 8

Which of the following laboratory techniques is most commonly used to compare and quantify CD markers on cells?

Accepted Answer

Flow cytometry

Answer

Western blot

Answer

ELISA

Answer

Immunohistochemistry

Question 9

A lymphoma characterized by the presence of centrocytes and centroblasts, along with BCL2 positivity and CD10 expression, is most commonly associated with which chromosomal translocation?

Accepted Answer

t(14 ; 18)

Answer

t(2 ; 5)

Answer

t(11 ; 14)

Answer

t(8 ; 14)

Question 10

The following image shows:

Accepted Answer

Jamshidi needle

Answer

Epidural needle

Answer

Pleural biopsy needle

Answer

Quincke's needle

Hematopathology — MCQs

Hematopathology — MCQs

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