Hematopathology Practice Questions

Q: Eosinopenia occurs in which of the following conditions?

Cushing's disease. Cushing’s Disease is the correct answer because it is characterized by an excess of endogenous cortisol [1]. Glucocorticoids cause eosinopenia (a decrease in the number of circulating eosinophils) by promoting their sequestration in the spleen and lungs and inducing apoptosis of eosinophils. This is part of the classic "steroid-induced leukogram," which typically shows neutrophilia alongside lymphopenia, monocytopenia, and eosinopenia. Analysis of Incorrect Options: * Asthma: This is a Type I hypersensitivity reaction. Eosinophils are recruited to the airway mucosa, and peripheral eosinophilia is a common finding, reflecting the Th2-driven inflammatory response. * Hookworm Infestation: Helminthic infections are classic causes of eosinophilia. Eosinophils play a crucial role in the immune response against parasites by releasing major basic protein (MBP) and eosinophil cationic protein (ECP). * Chronic Myeloid Leukemia (CML): CML is a myeloproliferative neoplasm. It typically presents with a "leukemoid" picture involving an increase in all granulocytic cell lines, including neutrophils, basophils, and eosinophils. Basophilia and eosinophilia are important diagnostic clues for CML. High-Yield Clinical Pearls for NEET-PG: * Mnemonic for Eosinophilia (NAACP): Neoplasia, Allergy/Asthma, Addison’s disease, Connective tissue disorders, Parasites. * Addison’s vs. Cushing’s: While Cushing’s (high cortisol) causes eosinopenia, Addison’s disease (low cortisol) causes eosinophilia [1]. * Steroid Effect: Glucocorticoids "kick" neutrophils out of the marginated pool into the blood (neutrophilia) but "hide" eosinophils and lymphocytes (eosinopenia/lymphopenia).

Q: All of the following are true about beta-thalassemia trait, EXCEPT:

Patient requires blood transfusion. **Explanation:** The correct answer is **D (Patient requires blood transfusion)** because Beta-thalassemia trait (also known as Beta-thalassemia minor) is typically a **clinically asymptomatic** carrier state [1]. In this condition, there is a mutation in only one of the two beta-globin genes ($\beta/\beta^+$ or $\beta/\beta^0$). The remaining functional gene produces enough hemoglobin to maintain near-normal levels, making these patients transfusion-independent. Blood transfusions are reserved for Beta-thalassemia Major (Cooley’s Anemia), where both genes are defective. **Analysis of other options:** * **Option A:** Microcytic hypochromic anemia is a hallmark of thalassemia trait [1]. Due to reduced beta-chain synthesis, the hemoglobin content per cell is low (low MCH) and the cells are smaller (low MCV). * **Option B:** An **increased HbA2 (>3.5%)** is the diagnostic gold standard for Beta-thalassemia trait [3]. It occurs as a compensatory mechanism where delta-chain synthesis increases to offset the beta-chain deficiency. * **Option C:** HbF (Fetal hemoglobin) may be slightly elevated (usually 1–5%) in some cases of Beta-thalassemia trait, though it is significantly higher in the Major form. **High-Yield NEET-PG Pearls:** 1. **Mentzer Index:** Used to differentiate Iron Deficiency Anemia (IDA) from Thalassemia. **MCV/RBC count 13** suggests IDA. 2. **Peripheral Smear:** Characterized by **Target cells** (codocytes) and basophilic stippling [2]. 3. **NEET-PG Fact:** Unlike IDA, the RBC count in Beta-thalassemia trait is often **elevated** (polycythemia) despite low hemoglobin, as the bone marrow attempts to compensate.

Q: A 10-year-old child presents with anemia. Peripheral smear findings are shown below. What is the most probable type of anemia this child is suffering from?

Megaloblastic anemia. ***Megaloblastic anemia*** - Peripheral smear shows **hypersegmented neutrophils** (>5 lobes) and **macro-ovalocytes** (large, oval-shaped RBCs), pathognomonic findings of megaloblastic anemia. - Caused by **vitamin B12** or **folate deficiency**, leading to impaired DNA synthesis and characteristic morphological changes. *Hemolytic anemia* - Peripheral smear would show **spherocytes**, **schistocytes**, **polychromasia**, and **reticulocytosis** indicating RBC destruction. - **Elevated indirect bilirubin** and **LDH** would be present, with normal or increased reticulocyte count. *Aplastic anemia* - Peripheral smear demonstrates **pancytopenia** with **normocytic, normochromic** RBCs and absence of abnormal cell morphology. - **Bone marrow biopsy** shows hypocellularity with fatty replacement, not the megaloblastic changes seen here. *Iron deficiency anemia* - Peripheral smear reveals **microcytic, hypochromic** RBCs with **pencil cells** and **target cells**. - **Low serum ferritin** and **elevated TIBC** would be characteristic, contrasting with the macrocytic findings in this case.

Question 1

A 20-year-old male presents with weakness, jaundice, and hematuria. He has a history of similar, self-limiting episodes and unusual substance consumption. Examination reveals mild jaundice and splenomegaly. Lab findings include increased indirect bilirubin, hemoglobinemia, hemoglobinuria, absent haptoglobin, raised LDH, hemosiderinuria, and reticulocytosis. Which peripheral blood smear finding is most likely associated with this condition?

Accepted Answer

Smear showing Pappenheimer bodies.

Answer

Smear showing target cells and bite cells.

Answer

Smear showing schistocytes and helmet cells.

Answer

Smear showing rouleaux formation.

Question 2

Eosinopenia occurs in which of the following conditions?

Accepted Answer

Cushing's disease

Answer

Asthma

Answer

Hookworm infestation

Answer

Chronic myeloid leukemia

Question 3

Necrotizing ragged ulceration with no apparent inflammatory response is indicative of which of the following conditions?

Accepted Answer

Agranulocytosis

Answer

Leukocytosis

Answer

Polycythemia vera

Answer

Sickle cell anemia

Question 4

Which of the following is NOT included in the myeloproliferative neoplasms?

Accepted Answer

Erythroleukemia

Answer

Angiogenic myeloid metaplasia

Answer

Thrombocythemia

Answer

Megaloblastic hyperplasia

Question 5

All of the following are true about beta-thalassemia trait, EXCEPT:

Accepted Answer

Patient requires blood transfusion

Answer

Microcytic hypochromic blood picture

Answer

Increased HbA2

Answer

Increased HbF

Question 6

A 17-year-old woman's urine becomes red after being given sulfonamides for a urinary tract infection. Both urine and serum test positive for free hemoglobin, and the urine red cell count is 1.2 million/mm3. A peripheral blood smear shows normocytic and normochromic red cells and a few "bite cells." Deficiency of which of the following substances is most likely responsible for these symptoms?

Accepted Answer

Glucose-6-phosphate dehydrogenase

Answer

Alpha-chain of hemoglobin

Answer

Beta-chain of hemoglobin

Answer

Glycoprotein IIb/IIIa

Question 7

A 10-year-old child presents with anemia. Peripheral smear findings are shown below. What is the most probable type of anemia this child is suffering from?

Accepted Answer

Megaloblastic anemia

Answer

Hemolytic anemia

Answer

Aplastic anemia

Answer

Iron deficiency anemia

Question 8

The autohemolysis test is positive in which of the following conditions?

Accepted Answer

Hereditary spherocytosis

Answer

Beta thalassemia

Answer

Vitamin E deficiency

Answer

Sickle cell disease

Question 9

An 8-year-old African boy presents with swelling in his jaw and massive facial disfiguration. Biopsy reveals a tumor invading the bone marrow of the jaw. The pathogenesis of this malignant neoplasm is associated with a virus that exhibits a tropism for which of the following cells?

Accepted Answer

Lymphocytes

Answer

Chondrocytes

Answer

Fibroblasts

Answer

Macrophages

Question 10

All of the following are seen in paroxysmal nocturnal hemoglobinuria (PNH) except?

Accepted Answer

Arterial thrombosis

Answer

Venous thrombosis

Answer

Aplastic anemia

Answer

Hemolytic anemia

Hematopathology — MCQs

Hematopathology — MCQs

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