Hematopathology Practice Questions

Q: Which of the following is NOT typically seen in hemolytic anemia?

Low reticulocyte count. In hemolytic anemia, the hallmark is the **premature destruction of red blood cells (RBCs)**. To compensate for this loss, the bone marrow becomes hyperactive, increasing the production and release of immature RBCs into the circulation. Therefore, a **high reticulocyte count** (reticulocytosis) is a characteristic finding, reflecting an appropriate marrow response. A low reticulocyte count suggests a production failure (e.g., aplastic anemia or nutritional deficiencies) rather than hemolysis. **Explanation of Incorrect Options:** * **A. Yellowing of eyes and sclera:** Hemolysis releases hemoglobin, which is metabolized into unconjugated bilirubin. When levels exceed the liver's conjugating capacity, **unconjugated hyperbilirubinemia** occurs, leading to clinical jaundice (icterus). * **B. Increased LDH:** Lactate Dehydrogenase is an enzyme found in high concentrations inside RBCs. When these cells rupture, LDH is released into the serum, making it a sensitive (though non-specific) marker of hemolysis. * **C. Decreased haptoglobin:** Haptoglobin is a plasma protein that binds free hemoglobin. In intravascular hemolysis, haptoglobin levels drop significantly as it is consumed while clearing the released hemoglobin from the circulation [1]. **NEET-PG High-Yield Pearls:** * **Markers of Hemolysis:** ↑ Indirect Bilirubin, ↑ LDH, ↑ Reticulocytes, and ↓ Haptoglobin [1]. * **Aplastic Crisis:** If a patient with chronic hemolysis (like Spherocytosis or Sickle Cell) suddenly presents with a **low reticulocyte count**, suspect **Parvovirus B19 infection**. * **Urinalysis:** Look for hemosiderinuria and hemoglobinuria in cases of intravascular hemolysis [1].

Q: MCV > 100 fL in all of the following except?

Lead poisoning. **Explanation:** The Mean Corpuscular Volume (MCV) measures the average size of red blood cells (RBCs). An MCV > 100 fL indicates **macrocytosis**, while an MCV < 80 fL indicates **microcytosis** [2]. **Why Lead Poisoning is the Correct Answer:** Lead poisoning is a classic cause of **microcytic hypochromic anemia** (MCV < 80 fL). Lead inhibits key enzymes in the heme synthesis pathway, specifically **delta-aminolevulinate dehydratase (ALAD)** and **ferrochelatase**. This inhibition prevents the incorporation of iron into protoporphyrin, resulting in smaller, pale RBCs. Therefore, it does not cause macrocytosis. **Analysis of Incorrect Options:** * **Alcoholic Liver Disease:** Chronic alcohol consumption is a common cause of non-megaloblastic macrocytosis. It occurs due to the direct toxic effect of ethanol on the bone marrow and alterations in the RBC lipid membrane. * **Folate Deficiency:** This leads to **megaloblastic anemia** [3]. Lack of folate impairs DNA synthesis (specifically thymidine production), resulting in nuclear-cytoplasmic dyssynchrony where the cell grows but cannot divide its nucleus properly, leading to very high MCV (>110 fL) [3]. * **Reticulocytosis:** Reticulocytes (immature RBCs) are physically larger than mature erythrocytes. In conditions with high RBC turnover (like hemolysis), a high reticulocyte count will falsely elevate the average MCV. **NEET-PG High-Yield Pearls:** 1. **Basophilic Stippling:** A hallmark of lead poisoning (due to inhibition of pyrimidine 5'-nucleotidase), though also seen in thalassemia [1]. 2. **Burton’s Line:** Bluish-purple line on the gums associated with chronic lead poisoning [4]. 3. **Megaloblastic vs. Non-megaloblastic:** Folate/B12 deficiency shows hypersegmented neutrophils; Alcohol/Hypothyroidism/Liver disease typically do not. 4. **Drug-induced Macrocytosis:** Common culprits include Hydroxyurea, Methotrexate, and Zidovudine.

Q: In a patient with acute leukemia, the immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, and CD 13+ve. What is the probable diagnosis?

Biphenotypic leukemia. ### Explanation **1. Why Biphenotypic Leukemia is Correct:** Biphenotypic Acute Leukemia (BAL), now classified under **Mixed Phenotype Acute Leukemia (MPAL)** by the WHO, occurs when a single population of blasts expresses markers of more than one lineage. In this case, the blasts express **B-lymphoid markers (CD19, CD10)** and **Myeloid markers (CD33, CD13)**. According to the scoring system (EGIL) or WHO criteria, the co-expression of strong lineage-specific markers from two different lineages (B-cell and Myeloid) confirms a mixed phenotype rather than a lineage-restricted leukemia. **2. Why Incorrect Options are Wrong:** * **B. Acute Lymphoblastic Leukemia (ALL):** While CD19 and CD10 are classic B-ALL markers, the significant expression of CD33 and CD13 (myeloid markers) excludes a diagnosis of pure ALL. * **C. AML-M2:** This is a myeloid leukemia characterized by the t(8;21) translocation. While it may occasionally show "lineage infidelity" (like CD19 expression), the presence of strong B-cell markers (CD10/CD19) alongside myeloid markers in a blast population points toward MPAL. * **D. AML-M0:** This is minimally differentiated AML. Blasts are negative for myeloperoxidase (MPO) and typically do not express lymphoid markers like CD10 or CD19. **3. High-Yield Clinical Pearls for NEET-PG:** * **MPAL Definition:** Requires meeting specific criteria for more than one lineage (e.g., MPO for Myeloid; CD19/CD22/CD79a for B-lineage; cytoplasmic CD3 for T-lineage). * **Common Translocations:** MPAL is frequently associated with **t(9;22)** (Philadelphia chromosome) or **MLL gene rearrangements** (11q23). * **Prognosis:** Generally carries a **poorer prognosis** compared to lineage-specific AML or ALL. * **CD10 (CALLA):** A high-yield marker for Common ALL, but its presence alongside myeloid markers is a hallmark of biphenotypic presentation.

Question 1

A 54-year-old male presents with massive splenomegaly, early fatigue, malaise, low-grade fever, gout, increased susceptibility to infections, anemia, a total leukocyte count of 125,000/mm³, and thrombocytopenia with easy bruising. Which chromosomal translocation is most commonly associated with this diagnosis?

Accepted Answer

t(9;22)

Answer

t(11;17)

Answer

del(5q)

Answer

None of the above

Question 2

A 48-year-old woman presented with a two-month history of weakness. On examination, cervical lymph nodes were enlarged, and the spleen was palpable 2 cm below the costal margin. Her hemoglobin was 10.5 g/dL, platelet count was 237 x 10^9/L, and total leukocyte count was 40 x 10^9/L, which included 80% mature lymphoid cells with coarse clumped chromatin. Bone marrow revealed a nodular lymphoid infiltrate. The peripheral blood lymphoid cells were positive for CD19, CD5, CD20, and CD23 and were negative for CD79b and FMC-7. What is the most likely diagnosis?

Accepted Answer

Chronic lymphocytic leukemia.

Answer

T-cell rich B-cell lymphoma with leukemic spillover into the blood.

Answer

Mantle cell lymphoma.

Answer

A definitive diagnosis cannot be made in this patient without a lymph node biopsy.

Question 3

Which of the following is NOT typically seen in hemolytic anemia?

Accepted Answer

Low reticulocyte count

Answer

Yellowing of eyes and sclera

Answer

Increased LDH

Answer

Decreased haptoglobin

Question 4

Destruction of Heinz bodies in the spleen is performed by which cells?

Accepted Answer

Macrophages

Answer

Lymphocytes

Answer

Neutrophils

Answer

Fibroblasts

Question 5

A 40-year-old male who underwent splenectomy 20 years ago presents for a peripheral blood smear examination. What would be observed?

Accepted Answer

Howell-Jolly bodies

Answer

Dohle bodies

Answer

Hypersegmented neutrophils

Answer

Spherocytes

Question 6

In sickle cell anemia, which of the following is true?

Accepted Answer

Autosplenectomy due to thrombosis and infarction

Answer

Microcytosis

Answer

Microcardia

Answer

Splenomegaly

Question 7

What is the most common variant of lymphoma seen in HIV-positive patients?

Accepted Answer

Immunoblastic Lymphoma

Answer

Burkitt's Lymphoma

Answer

Primary CNS Lymphoma

Answer

Mantle Cell Lymphoma

Question 8

MCV > 100 fL in all of the following except?

Accepted Answer

Lead poisoning

Answer

Alcoholic liver disease

Answer

Folate deficiency

Answer

Reticulocytosis

Question 9

In a patient with acute leukemia, the immunophenotype pattern is CD 19+ve, CD 10+ve, CD33+ve, and CD 13+ve. What is the probable diagnosis?

Accepted Answer

Biphenotypic leukemia

Answer

Acute lymphoblastic leukemia (ALL)

Answer

Acute myeloid leukemia - M2 subtype (AML-M2)

Answer

Acute myeloid leukemia - M0 subtype (AML-M0)

Question 10

Which of the following statements is true about Multiple Myeloma?

Accepted Answer

Monoclonal immunoglobulin (M spike) is increased.

Answer

Plasma cells deposit directly in glomerular capillaries, causing kidney damage.

Answer

Interleukin-8 (IL-8) is a marker for bone lesions.

Answer

Alkaline phosphatase levels are invariably increased.

Hematopathology — MCQs

Hematopathology — MCQs

On this page

Practice by Chapter

Want unlimited practice?