Hematopathology Practice Questions

Q: What is the preservation solution used for storing blood for transfusion?

CDP-A. **Explanation:** The correct answer is **CPD-A (Citrate Phosphate Dextrose Adenine)**. This is the standard preservative solution used in blood banking to maintain the viability and function of red blood cells (RBCs) during storage. **Why CPD-A is the correct choice:** Each component of CPD-A serves a specific physiological purpose: * **Citrate:** Acts as an anticoagulant by chelating calcium ions, preventing the coagulation cascade. * **Phosphate:** Acts as a buffer to maintain the pH of the blood, preventing excessive acidity during storage. * **Dextrose (Glucose):** Provides a substrate for glycolysis, allowing the RBCs to generate ATP. * **Adenine:** Enhances ATP synthesis, which extends the shelf life of the blood from 21 days (standard CPD) to **35 days**. **Analysis of Incorrect Options:** * **A & B (Heparin/Citrate + Glucose):** While citrate and glucose are components, they lack the buffering capacity of phosphate and the ATP-boosting properties of adenine, leading to a shorter shelf life and poorer cell survival. Heparin is rarely used as it is not a preservative and activates platelets. * **C (EDTA):** While EDTA is an excellent anticoagulant for laboratory hematology (CBC), it is **never** used for transfusion because it damages RBC membranes and is toxic in large systemic doses [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Shelf Life:** CPD-A extends storage to **35 days**. If SAGM (Saline-Adenine-Glucose-Mannitol) is added, storage extends to **42 days**. * **Storage Temperature:** Whole blood/RBCs must be stored at **2°C to 6°C**. * **Storage Lesion:** During storage, there is a decrease in 2,3-DPG (shifting the oxygen dissociation curve to the left) and an increase in extracellular Potassium (risk of hyperkalemia in neonates/massive transfusions).

Q: What is the cause of congestive splenomegaly?

Budd Chiari Syndrome. **Explanation:** **Congestive splenomegaly** occurs when there is an obstruction to the venous outflow of the spleen, leading to chronic passive congestion and subsequent enlargement. **Why Budd-Chiari Syndrome is Correct:** Budd-Chiari Syndrome (BCS) is characterized by the obstruction of hepatic venous outflow (at the level of the hepatic veins or the inferior vena cava). This leads to increased intrahepatic pressure, which is transmitted backward into the portal venous system (**Portal Hypertension**) [1]. Since the splenic vein drains into the portal vein, this back-pressure causes blood to pool in the splenic sinusoids, resulting in congestive splenomegaly. Other common causes include Cirrhosis and Portal Vein Thrombosis [1]. **Analysis of Incorrect Options:** * **Visceral Leishmaniasis (Kala-azar):** Causes massive splenomegaly due to **reticuloendothelial hyperplasia** (proliferation of macrophages containing Amastigote/LD bodies), not venous congestion. * **Gaucher’s Disease:** This is a lysosomal storage disorder where glucocerebroside accumulates in macrophages (Gaucher cells). The splenomegaly is due to **infiltrative storage**, making it a "storage splenomegaly." * **Hodgkin’s Lymphoma:** Splenomegaly here is due to **neoplastic infiltration** by malignant cells (Reed-Sternberg cells) and reactive lymphoid hyperplasia. **NEET-PG High-Yield Pearls:** * **Massive Splenomegaly (crosses midline/umbilicus):** Chronic Myeloid Leukemia (CML), Myelofibrosis, Visceral Leishmaniasis, and Malaria (Tropical Splenomegaly Syndrome). * **Gaucher’s Disease:** Most common lysosomal storage disorder; look for "crinkled paper" cytoplasm in macrophages. * **Budd-Chiari Triad:** Abdominal pain, ascites, and hepatomegaly. * **Splenic Infarction:** Common in Sickle Cell Anemia and Infective Endocarditis; presents with acute left upper quadrant pain.

Question 1

Which of the following findings is not compatible with a diagnosis of juvenile myelomonocytic leukemia?

Accepted Answer

Presence of bcr/abl fusion gene

Answer

Peripheral blood monocytosis, more than 1 x 10^9/L

Answer

Increased hemoglobin F levels for age

Answer

GM-CSF hypersensitivity of myeloid progenitors in vitro

Question 2

Delayed prolonged bleeding after a minor surgery is caused by a defect in which of the following?

Accepted Answer

Secondary hemostasis.

Answer

Primary hemostasis.

Answer

Defect in the capillary bed to support the clot.

Answer

Defect in connective tissue to support capillaries.

Question 3

Which of the following conditions is associated with a BRAF mutation?

Accepted Answer

Hairy cell leukemia

Answer

Langerhans cell histiocytosis (LCH)

Answer

Colon carcinoma

Answer

Acute myeloid leukemia (AML)

Question 4

What is the preservation solution used for storing blood for transfusion?

Accepted Answer

CDP-A

Answer

Heparin + dextrose

Answer

Citrate + glucose

Answer

EDTA

Question 5

All of the following are WHO classified Myelodysplastic Syndromes except:

Accepted Answer

Chronic myeloid leukemia (CML)

Answer

Refractory anemia with excess blasts

Answer

Refractory anemia with ringed sideroblasts

Answer

Refractory anemia

Question 6

Eosinophilia is typically found in infections caused by which of the following organisms?

Accepted Answer

Strongyloides

Answer

Cryptococcus

Answer

Human Papillomavirus (HPV)

Answer

Typhoid

Question 7

Prolonged PT and normal PTT may be seen in which of the following conditions?

Accepted Answer

None of the above

Answer

Thrombocytopenia

Answer

Disseminated Intravascular Coagulation (DIC)

Answer

Vitamin K deficiency

Question 8

A 6-month-old child with sickle cell anemia has a chronically enlarged spleen. By 5 years of age, the child's spleen is no longer palpable. The decrease in size is most likely related to which of the following?

Accepted Answer

Infarctions

Answer

Chronic infection

Answer

Hodgkin's lymphoma

Answer

Non-Hodgkin's lymphoma

Question 9

A round cell having fine nuclear chromatin, prominent nucleoli, and fine azurophilic granules. What is this cell?

Accepted Answer

Myeloblast

Answer

Lymphoblast

Answer

Monoblast

Answer

None of the above

Question 10

What is the cause of congestive splenomegaly?

Accepted Answer

Budd Chiari Syndrome

Answer

Visceral Leishmaniasis

Answer

Gaucher's Disease

Answer

Hodgkin's Lymphoma

Hematopathology — MCQs

Hematopathology — MCQs

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