Hematopathology Practice Questions

Q: Which of the following is most likely to cause a hypochromic microcytic anemia?

Iron deficiency anemia. **Explanation:** **Iron Deficiency Anemia (IDA)** is the most common cause of **microcytic hypochromic anemia** worldwide [1], [4]. The underlying mechanism involves a decrease in hemoglobin synthesis. Hemoglobin is composed of heme (iron + protoporphyrin) and globin. When iron is deficient, heme production drops, leading to fewer hemoglobin molecules per cell. Consequently, erythrocytes undergo extra divisions to maintain concentration, resulting in smaller cells (**Microcytic: MCV 100 fL) [2]. Folate is essential for DNA synthesis; its deficiency leads to impaired nuclear maturation while cytoplasmic growth continues, resulting in large, oval red cells and hypersegmented neutrophils. * **Hereditary spherocytosis:** This is a normocytic or mildly microcytic hemolytic anemia. Crucially, it is **hyperchromic** (elevated MCHC) because the loss of membrane surface area causes the cell to become spherical and densely packed with hemoglobin. * **Sickle cell anemia:** This is typically a **Normocytic normochromic** anemia. While it is a qualitative hemoglobinopathy (HbS), the size and color of the cells are generally normal unless there is a co-existing iron deficiency or alpha-thalassemia. **High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis for Microcytic Anemia (TAIL):** **T**halassemia, **A**nemia of Chronic Disease (late stage), **I**ron Deficiency, **L**ead poisoning/Sideroblastic anemia [1]. * **Best Screening Test for IDA:** Serum Ferritin (decreased). * **Earliest Sign of Response to Iron Therapy:** Reticulocytosis (usually within 5–7 days). * **Mentzer Index:** MCV/RBC count. If ** 13**, suspect Iron Deficiency Anemia.

Q: Which of the following are features of iron deficiency anemia?

Decreased TIBC. **Explanation:** Iron Deficiency Anemia (IDA) is a microcytic hypochromic anemia characterized by a depletion of body iron stores [1]. The question asks to identify a feature that is **NOT** typically seen in IDA (or specifically, which of the listed options is incorrect regarding the pathophysiology of IDA). **Understanding the Correct Answer (C):** In IDA, **Total Iron Binding Capacity (TIBC)** is **increased**, not decreased [1]. TIBC is a functional measurement of Transferrin. When iron stores are low, the liver compensates by increasing the synthesis of Transferrin to maximize the transport of any available iron. Therefore, an elevated TIBC is a hallmark diagnostic feature of IDA [1]. **Analysis of Incorrect Options:** * **A. Increased RDW:** Red Cell Distribution Width (RDW) measures the variation in RBC size (anisocytosis). IDA is one of the first anemias to show an increased RDW as the body begins producing smaller cells alongside normal ones. * **B. Decreased Serum Iron:** This is a direct consequence of depleted iron levels and a primary finding in IDA [1]. * **D. Decreased Serum Ferritin:** Ferritin reflects total body iron stores. A low serum ferritin is the **most specific** initial laboratory finding for IDA [1]. **NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Bone marrow aspiration (Prussian blue staining) showing absent haemosiderin in macrophages. * **Earliest Sign:** Decreased serum ferritin [1]. * **Differential Diagnosis:** In **Anemia of Chronic Disease (ACD)**, TIBC is decreased and Ferritin is increased (as it acts as an acute-phase reactant), which helps distinguish it from IDA. * **Mentzer Index:** (MCV/RBC count) > 13 suggests IDA, while < 13 suggests Thalassemia trait.

Question 1

Direct Coombs test positive is seen in all of the following conditions EXCEPT?

Accepted Answer

Aplastic anemia

Answer

ABO incompatibility

Answer

Hemolytic disease of the newborn

Answer

Autoimmune hemolysis

Question 2

A 7-month-old child presents with failure to thrive and a hemoglobin level of 4.4 g/dL. Peripheral smear examination reveals very small red blood cells with marked pallor. Laboratory tests show very low levels of hemoglobin A, with elevated fractions of hemoglobin A2 and hemoglobin F. Which of the following underlying mechanisms is most likely responsible for these findings?

Accepted Answer

Insufficient production of beta-globin

Answer

Amino acid substitution on the beta-globin chain

Answer

Antibody against fetal red blood cells

Answer

Defect in cytoskeletal proteins

Question 3

Synthesis of which of the following clotting factors is not affected in liver disease?

Accepted Answer

Factor VIII

Answer

Factor II

Answer

Factor V

Answer

Factor IX

Question 4

A 5-year-old boy is being evaluated for recurrent epistaxis and other abnormal bleeding episodes, including excessive bleeding from the umbilical cord. Laboratory studies reveal the following: decreased hemoglobin (with microcytic hypochromic red cell indices), normal platelet count, markedly prolonged prothrombin time (PT) and partial thromboplastin time (PTT), and unmeasurable thrombin time (TT). Platelet aggregation studies reveal a normal platelet response to ristocetin, but with other substances (including collagen, ADP, and epinephrine), this patient's platelets exhibit a primary wave defect. Based on these findings, what is the most likely diagnosis?

Accepted Answer

Afibrinogenemia

Answer

Bernard-Soulier syndrome

Answer

Glanzmann's thrombasthenia

Answer

Wiskott-Aldrich syndrome

Question 5

Massive splenomegaly is not seen in which of the following conditions?

Accepted Answer

Sickle cell anemia

Answer

Malaria

Answer

Chronic myelogenous leukemia

Answer

Syphilis

Question 6

What is true about Burkitt's lymphoma?

Accepted Answer

CD34 negative and surface immunoglobulin positive

Answer

CD34 positive and surface immunoglobulin positive

Answer

CD34 positive and surface immunoglobulin negative

Answer

CD34 negative and surface immunoglobulin negative

Question 7

Which of the following is most likely to cause a hypochromic microcytic anemia?

Accepted Answer

Iron deficiency anemia

Answer

Folate deficiency

Answer

Hereditary spherocytosis

Answer

Sickle cell anemia

Question 8

A 65-year-old man presents with anemia and back pain. A panoramic radiograph reveals multiple radiolucencies. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma

Answer

Osteosarcoma

Answer

Giant cell granuloma

Answer

Eosinophilic granuloma

Question 9

Which of the following are features of iron deficiency anemia?

Accepted Answer

Decreased TIBC

Answer

Increased RDW

Answer

Decreased serum iron

Answer

Decreased serum ferritin

Question 10

Which clotting factor deficiency is asymptomatic?

Accepted Answer

XII

Answer

II

Answer

V

Answer

XI

Hematopathology — MCQs

Hematopathology — MCQs

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