Hematopathology Practice Questions

Q: What is the shelf life of CPD blood?

3 weeks. **Explanation:** The shelf life of stored blood is primarily determined by the **anticoagulant-preservative solution** used, which maintains red cell viability and ATP levels. **1. Why Option A is correct:** **CPD (Citrate Phosphate Dextrose)** is a standard preservative that allows for a storage life of **21 days (3 weeks)** when stored at 2-6°C. * **Citrate** acts as an anticoagulant by chelating calcium. * **Phosphate** acts as a buffer to maintain pH. * **Dextrose** provides a substrate for glycolysis to generate ATP, ensuring the survival of at least 70% of the transfused RBCs 24 hours post-transfusion. **2. Why other options are incorrect:** * **Option B (6 weeks):** This corresponds to the shelf life of blood stored with **SAGM (Saline Adenine Glucose Mannitol)** or other additive solutions (e.g., AS-1, AS-3, AS-5), which extend storage to **42 days**. * **Options C & D (9 and 12 weeks):** These are incorrect as standard liquid storage of whole blood or packed red cells does not exceed 42 days. Beyond this period, "storage lesions" (loss of 2,3-DPG, hyperkalemia, and hemolysis) make the blood clinically ineffective or dangerous. **High-Yield Clinical Pearls for NEET-PG:** * **ACD (Acid Citrate Dextrose):** Shelf life is **21 days** (similar to CPD, but CPD is preferred as it maintains better pH). * **CPDA-1 (CPD + Adenine):** The addition of Adenine boosts ATP synthesis, extending the shelf life to **35 days**. * **Storage Temperature:** Blood must be stored strictly at **2°C to 6°C**. * **Platelets:** Stored at **20-24°C** with constant agitation for only **5 days**. * **FFP (Fresh Frozen Plasma):** Stored at **-18°C or colder** for up to **1 year**.

Q: Which of the following is absent in hemolytic anemia?

Increased hematocrit. Hemolytic anemia is characterized by the premature destruction of red blood cells (RBCs). The core pathophysiology involves a decrease in the total RBC mass, which leads to a **decreased hematocrit** and hemoglobin level. Therefore, an **increased hematocrit (Option D)** is physiologically impossible in anemia and is the correct answer. **Analysis of Options:** * **Increased indirect bilirubin (Option A):** When RBCs break down, heme is converted into unconjugated (indirect) bilirubin. * **Jaundice (Option B):** This is a clinical manifestation of increased indirect bilirubin [1]. It is a classic feature of hemolytic anemia, often described as "acholuric jaundice" (no bilirubin in urine). * **Increased reticulocyte count (Option C):** This represents the bone marrow's compensatory response to anemia. Erythropoietin levels rise, stimulating the marrow to release immature RBCs (reticulocytes) into the peripheral blood. **NEET-PG High-Yield Pearls:** 1. **Markers of Hemolysis:** Increased LDH (most sensitive), increased indirect bilirubin, and **decreased Serum Haptoglobin** (haptoglobin binds free hemoglobin). 2. **Intravascular vs. Extravascular:** Hemoglobinuria and hemosiderinuria are specific to *intravascular* hemolysis (e.g., G6PD deficiency, PNH) [2]. 3. **Peripheral Smear:** Look for **Schistocytes** (fragmented cells) in microangiopathic hemolytic anemia (TTP/HUS) and **Spherocytes** in Hereditary Spherocytosis or AIHA. 4. **Corrected Reticulocyte Count (CRC):** In anemia, always calculate the CRC to determine if the marrow response is adequate (>2% suggests hemolysis or acute blood loss).

Q: A biopsy of a reasonably well-demarcated mass of the nasopharynx from a 30-year-old man demonstrates a plasma cell proliferation. Serum electrophoresis shows a small monoclonal IgG spike. Bone marrow evaluation fails to demonstrate plasma cell proliferation, and no lesions are seen on extensive skeletal x-rays. Which of the following is the most likely diagnosis?

Plasmacytoma. **Explanation:** The clinical presentation describes an **Extramedullary Plasmacytoma (EMP)**. This is a localized proliferation of neoplastic plasma cells occurring outside the bone marrow, most commonly in the upper respiratory tract (80% of cases occur in the head and neck, with the nasopharynx and paranasal sinuses being prime sites). **Why Plasmacytoma is correct:** The diagnosis is confirmed by the presence of a localized plasma cell mass in the nasopharynx combined with the **absence** of systemic features of Multiple Myeloma (normal bone marrow, no lytic bone lesions, and no CRAB features—Calcium elevation, Renal failure, Anemia, or Bone lesions). While a small monoclonal (M) protein spike can be seen in 25% of EMP cases, it does not automatically imply systemic disease. **Why other options are incorrect:** * **Multiple Myeloma:** Ruled out by the normal bone marrow biopsy and the absence of skeletal lytic lesions on X-ray. * **Monoclonal Gammopathy of Undetermined Significance (MGUS):** MGUS is characterized by an asymptomatic M-protein spike (<3g/dL) without a localized tumor mass or end-organ damage. This patient has a physical mass (plasmacytoma). * **Heavy Chain Disease:** This is a rare B-cell lymphoproliferative disorder characterized by the production of truncated heavy chains without light chains; it does not typically present as a localized nasopharyngeal mass. **NEET-PG High-Yield Pearls:** * **Treatment of Choice:** Radiotherapy (EMP is highly radiosensitive). * **Progression:** Unlike Solitary Plasmacytoma of Bone (SPB), Extramedullary Plasmacytoma (EMP) has a lower rate of conversion to Multiple Myeloma (approx. 15%). * **Most common site in Head & Neck:** Nasopharynx and Paranasal sinuses. * **Diagnostic Criteria:** Tissue biopsy showing plasma cells, <10% plasma cells in bone marrow, and negative skeletal survey.

Question 1

Which virus is known to cause hemopoietic carcinoma?

Accepted Answer

Epstein-Barr virus (EBV)

Answer

Human T-lymphotropic virus type I (HTLV-I)

Answer

Human herpesvirus 8 (HHV-8)

Answer

Cytomegalovirus (CMV)

Question 2

Which of the following conditions does NOT cause a prolonged PTT?

Accepted Answer

Idiopathic Thrombocytopenic Purpura (ITP)

Answer

Hemophilia A

Answer

Von Willebrand disease

Answer

Christmas disease

Question 3

The direct globulin test is positive in which of the following conditions?

Accepted Answer

Paroxysmal cold hemoglobinuria

Answer

Paroxysmal nocturnal hemoglobinuria (PNH)

Answer

Sickle cell anemia

Answer

Thalassemia

Question 4

Which of the following statements is NOT true regarding idiopathic thrombocytopenic purpura?

Accepted Answer

Antibodies of IgM class

Answer

Autoantibodies to Gp IIb/IIIa or Ib/IX

Answer

Increased megakaryocytes in the bone marrow

Answer

Spleen is normal in size

Question 5

After an accident, a male patient presented for routine evaluation. His RBCs showed Cabot's rings. What is the likely condition responsible?

Accepted Answer

Post-splenectomy state

Answer

Acquired hemolytic anemia

Answer

Hemochromatosis

Answer

Thalassemia

Question 6

What is the shelf life of CPD blood?

Accepted Answer

3 weeks

Answer

6 weeks

Answer

9 weeks

Answer

12 weeks

Question 7

All of the following NHL involve the white pulp of the spleen EXCEPT?

Accepted Answer

Hairy cell leukemia

Answer

Burkitt lymphoma

Answer

Follicular lymphoma

Answer

Mantle cell lymphoma

Question 8

Patients with Immune Thrombocytopenic Purpura (ITP) have antibodies to which of the following?

Accepted Answer

Platelet membrane glycoproteins

Answer

Platelet ADP

Answer

Platelet membrane cholesterol

Answer

Platelet membrane lipids

Question 9

Which of the following is absent in hemolytic anemia?

Accepted Answer

Increased hematocrit

Answer

Increased indirect bilirubin

Answer

Jaundice

Answer

Increased reticulocyte count

Question 10

A biopsy of a reasonably well-demarcated mass of the nasopharynx from a 30-year-old man demonstrates a plasma cell proliferation. Serum electrophoresis shows a small monoclonal IgG spike. Bone marrow evaluation fails to demonstrate plasma cell proliferation, and no lesions are seen on extensive skeletal x-rays. Which of the following is the most likely diagnosis?

Accepted Answer

Plasmacytoma

Answer

Heavy chain disease

Answer

Monoclonal gammopathy of undetermined significance

Answer

Multiple myeloma

Hematopathology — MCQs

Hematopathology — MCQs

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