Hematopathology Practice Questions

Q: Lead poisoning is characterised by:

Microcytic anaemia. ***Microcytic anaemia*** - Lead poisoning inhibits enzymes involved in **heme synthesis**, leading to impaired hemoglobin production. [1] - This results in the formation of smaller red blood cells with reduced hemoglobin content, hence **microcytic** (small cell) and often **hypochromic** (pale cell) anemia. *Eosinophilic stippling of WBC* - **Eosinophilic stippling** refers to the presence of fine, reddish-pink granules within eosinophils, which is a normal characteristic of these cells. - **Basophilic stippling** of red blood cells, not eosinophilic stippling of WBCs, is a characteristic finding in lead poisoning due to ribosomal aggregation. *Normochromic normocytic anaemia* - This type of anemia involves red blood cells that are normal in size and hemoglobin content, often seen in conditions like **acute blood loss** or **chronic kidney disease**. - Lead poisoning typically impairs hemoglobin synthesis, leading to **microcytic** and often **hypochromic** red cells. [1] *Hypochromic normocytic anaemia* - **Hypochromic normocytic anemia** means the red blood cells are pale (low hemoglobin) but normal in size. - While lead poisoning can cause hypochromia, it primarily leads to **microcytosis** (small red blood cells) due to the impaired heme synthesis. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-419.

Q: In APML (Acute Promyelocytic Leukemia), all of the following are seen except:

CD 15/34 both seen in same cell. ***CD 15/34 both seen in same cell*** - This statement is incorrect because **Acute Promyelocytic Leukemia (APML)** is characterized by **CD34 negativity**, meaning CD34 is typically absent in APML cells. - While **CD15 may be positive** in APML, **CD34 is negative** in the vast majority of cases (unlike other AML subtypes where CD34 is often positive). - Therefore, **CD15 and CD34 are NOT both seen in the same cell** in APML. - The disease involves **immature myeloid cells** at the promyelocyte stage, which are beyond the most primitive stem cell stage (hence the lack of CD34 expression). *Retinoic acid is used in treatment* - **All-trans retinoic acid (ATRA)** is a cornerstone of treatment for APML. - ATRA induces differentiation of the **promyelocytes**, which helps overcome the **differentiation block** caused by the PML-RARA fusion protein. *15/17 translocation may be seen* - The characteristic genetic abnormality in APML is the **t(15;17) translocation** [1]. - This translocation results in the fusion of the **PML (promyelocytic leukemia) gene** on chromosome 15 with the **RARA (retinoic acid receptor alpha) gene** on chromosome 17 [2]. *Associated with Disseminated intravascular coagulation (DIC)* - APML is frequently associated with a high risk of developing **Disseminated Intravascular Coagulation (DIC)** [1]. - The abnormal promyelocytes release **procoagulant substances** that activate the coagulation cascade, leading to severe bleeding and thrombosis. **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. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 605-607.

Q: Most common cause of febrile non haemolytic transfusion reaction?

HLA mismatch. ***HLA mismatch*** - **Febrile non-hemolytic transfusion reactions (FNHTR)** are primarily caused by the recipient's antibodies reacting against donor leukocyte antigens (HLAs) [1]. - This reaction leads to the release of **pyrogenic cytokines** from donor leukocytes stored in the blood product, causing fever and chills [1]. *Rh mismatch* - **Rh mismatch** primarily causes **hemolytic transfusion reactions**, characterized by red blood cell destruction, not just fever without hemolysis [1]. - This type of reaction is typically severe and involves antibody-mediated red cell lysis [1]. *ABO mismatch* - **ABO mismatch** leads to the most severe and often fatal **acute hemolytic transfusion reactions**, involving rapid intravascular hemolysis [1]. - This is a direct immune response against incompatible red blood cell antigens, resulting in hemoglobinuria, renal failure, and shock, not just fever [1]. *All of the options* - This option is incorrect because while all listed conditions relate to transfusion, only **HLA mismatch** commonly causes FNHTRs. - **Rh and ABO mismatches** are associated with distinct and more severe hemolytic reactions.

Q: Necrotizing lymphadenitis is seen in

Kikuchi-Fujimoto disease. ***Kikuchi-Fujimoto disease*** - Kikuchi-Fujimoto disease (KFD), also known as **histiocytic necrotizing lymphadenitis**, is characterized by **necrotizing lymphadenitis** without granulocytic infiltration. - It typically presents with **cervical lymphadenopathy**, fever, and leukopenia, often in young women. *Kimura disease* - Kimura disease is characterized by chronic, painless **subcutaneous masses** and **lymphadenopathy**, often in the head and neck. - Histologically, it shows **follicular hyperplasia** and prominent **eosinophilic infiltration**, not necrotizing lymphadenitis. *Castleman disease* - Castleman disease is a group of rare disorders that involve **overgrowth of lymph node cells**, leading to enlarged lymph nodes. - Histologically, it presents with **hyaline vascular** or **plasma cell variants**, but not necrotizing changes. *Hodgkin's lymphoma* - Hodgkin's lymphoma is a type of cancer characterized by the presence of **Reed-Sternberg cells** within a heterogeneous inflammatory infiltrate. - While it affects lymph nodes, its characteristic features are specific giant cells and an inflammatory background, **not necrotizing lymphadenitis** as the primary finding [1]. **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. 592-593.

Q: Rosenthal's syndrome is due to deficiency of

XI. XI - **Rosenthal's syndrome**, also known as **Hemophilia C**, is an autosomal recessive disorder caused by a deficiency of **Factor XI (FXI)**. - This deficiency leads to a mild bleeding disorder, often characterized by **post-traumatic or postsurgical bleeding**, but spontaneous bleeding is rare. IX - Deficiency of **Factor IX** causes **Hemophilia B** (Christmas disease), an X-linked recessive bleeding disorder [1]. - Hemophilia B typically causes **moderate to severe bleeding** symptoms, including spontaneous joint and muscle bleeds [1]. VIII - Deficiency of **Factor VIII** causes **Hemophilia A** (classic hemophilia), the most common severe X-linked recessive bleeding disorder [1]. - Patients with Hemophilia A experience diverse bleeding manifestations, including **hemarthroses** (joint bleeding) and **deep muscle hematomas** [1]. XII - Deficiency of **Factor XII (Hageman factor)** is associated with a **prolonged activated partial thromboplastin time (aPTT)** but generally does not cause a bleeding disorder. - Patients with F XII deficiency are often **asymptomatic** and do not experience abnormal bleeding, though some may have an increased risk of thrombosis.

Q: Cause of ITP is

Antibody to platelets. The cause of ITP is: ***Antibody to platelets*** - **Immune thrombocytopenic purpura (ITP)** is an autoimmune disorder [1] characterized by the destruction of platelets due to the presence of **autoantibodies**, primarily targeting platelet surface glycoproteins like **GPIIb/IIIa**. - These antibodies lead to premature destruction or increased consumption [1] of platelets by the reticuloendothelial system, particularly in the spleen, resulting in **thrombocytopenia**. *Vasculitis* - **Vasculitis** is inflammation of the blood vessels, which can cause symptoms like purpura but typically does not primarily cause isolated severe thrombocytopenia as seen in ITP. - While it can lead to bleeding manifestations, the underlying mechanism is vascular inflammation, not direct platelet destruction by antibodies. *Antibody to vascular epithelium* - Antibodies to **vascular endothelium** are seen in conditions such as some forms of vasculitis or autoimmune disorders like lupus, but they directly target vessel walls, not platelets. - This typically leads to endothelial damage and inflammation, rather than isolated thrombocytopenia from platelet destruction. *Antibody to clotting factors* - Antibodies to **clotting factors** (e.g., Factor VIII inhibitors) cause **hemophilia-like bleeding disorders** by interfering with the coagulation cascade. - This mechanism results in impaired clot formation, not primarily in low platelet counts as is characteristic of ITP.

Q: Necrotizing lymphadenopathy is characteristically seen in:

Kikuchi disease. ***Kikuchi disease*** - Also known as **histiocytic necrotizing lymphadenitis**, it is characterized by **tender cervical lymphadenopathy** with histological evidence of **necrotizing lymphadenitis** with an influx of **histiocytes and immunoblasts**. - The disease is **self-limiting**, typically resolving in 1-4 months, though it can recur and is more common in **young women of Asian descent**. - Histology shows **paracortical necrosis** with abundant karyorrhectic debris and absence of neutrophils. *Non-Hodgkin's lymphoma* - This is a diverse group of **malignancies** originating from lymphocytes, primarily presenting as **lymphadenopathy** that is typically **painless** and can be widespread. - While some aggressive NHL subtypes may show areas of necrosis, the defining characteristic is **clonal proliferation of malignant lymphocytes** rather than the necrotizing histiocytic features of Kikuchi disease. *Castleman's disease* - This is a rare disorder characterized by the **overgrowth of lymphoid tissue**, presenting with **large, often solitary lymph nodes** (unicentric form) or generalized lymphadenopathy (multicentric form). - It is histologically distinguished by **hypervascularity** and **abnormal germinal centers** (onion-skinning pattern), not by necrotizing lymphadenopathy. *Kimura disease* - A **rare chronic inflammatory disorder** presenting with **subcutaneous nodules** and **lymphadenopathy**, commonly in the head and neck region [1]. - Histologically, it is characterized by **lymphoid hyperplasia with prominent eosinophilic infiltration** and increased vascularity, but **not necrosis** of lymph nodes [1]. **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. 592-593.

Question 1

Lead poisoning is characterised by:

Accepted Answer

Microcytic anaemia

Answer

Eosinophilic stippling of WBC

Answer

Normochromic normocytic anaemia

Answer

Hypochromic normocytic anaemia

Question 2

All of the following statements about Lupus Anticoagulant are true, EXCEPT:

Accepted Answer

Thrombotic spells can be followed by severe life threatening hemorrhage

Answer

May present with Recurrent Abortions

Answer

May occur with minimal clinical manifestations

Answer

May present with an isolated prolongation of APTT

Question 3

In APML (Acute Promyelocytic Leukemia), all of the following are seen except:

Accepted Answer

CD 15/34 both seen in same cell

Answer

Retinoic acid is used in treatment

Answer

15/17 translocation may be seen

Answer

Associated with Disseminated intravascular coagulation (DIC)

Question 4

Radiation is most commonly associated with which of the following cancer?

Accepted Answer

Leukemia

Answer

Lymphoma

Answer

Lung carcinoma

Answer

Osteosarcoma

Question 5

Most common cause of febrile non haemolytic transfusion reaction?

Accepted Answer

HLA mismatch

Answer

Rh mismatch

Answer

ABO mismatch

Answer

All of the options

Question 6

Necrotizing lymphadenitis is seen in

Accepted Answer

Kikuchi-Fujimoto disease

Answer

Kimura disease

Answer

Hodgkin's lymphoma

Answer

Castleman disease

Question 7

Rosenthal's syndrome is due to deficiency of

Accepted Answer

XI

Answer

IX

Answer

VIII

Answer

XII

Question 8

Cause of ITP is

Accepted Answer

Antibody to platelets

Answer

Vasculitis

Answer

Antibody to vascular epithelium

Answer

Antibody to clotting factors

Question 9

Necrotizing lymphadenopathy is characteristically seen in:

Accepted Answer

Kikuchi disease

Answer

Non-Hodgkin's lymphoma

Answer

Castleman's disease

Answer

Kimura disease

Question 10

Fetomaternal transfusion of fetal RBCs in mother can be detected by: UPSC 08; TN 08; AIIMS 10

Accepted Answer

Betke-Kleihauer test

Answer

Electrophoresis

Answer

Indirect Coomb's test

Answer

Direct Coomb's test

Hematopathology — MCQs

Hematopathology — MCQs

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