Hematopathology Practice Questions

Q: Which of the following is a common blood transfusion reaction?

Febrile nonhemolytic transfusion reaction. **Explanation:** **Correct Answer: A. Febrile nonhemolytic transfusion reaction (FNHTR)** FNHTR is the **most common** adverse reaction associated with the transfusion of blood products. It is defined as a rise in temperature of $\geq 1^\circ\text{C}$ during or shortly after transfusion, without any other explainable cause. * **Mechanism:** It is primarily caused by **preformed cytokines** (like IL-1, IL-6, and TNF-$\alpha$) that accumulate in the stored blood component or by recipient antibodies reacting against donor white blood cells (HLA antigens). * **Prevention:** The incidence has significantly decreased due to the routine use of **leukoreduction** (filtering out WBCs before storage). **Incorrect Options:** * **B. Hemolysis:** Acute hemolytic reactions (usually due to ABO incompatibility) are life-threatening but **rare** due to strict cross-matching protocols [1]. * **C. Transmission of infections:** With modern nucleic acid testing (NAT) and rigorous screening for HIV, Hepatitis B, and C, the risk of transfusion-transmitted infections is now extremely low. * **D. Electrolyte imbalance:** While complications like hyperkalemia or hypocalcemia (citrate toxicity) can occur, they are typically seen only in **massive transfusions** and are not common in routine single-unit transfusions. **NEET-PG High-Yield Pearls:** * **Most common overall reaction:** Febrile nonhemolytic transfusion reaction. * **Most common cause of transfusion-related death:** TRALI (Transfusion-Related Acute Lung Injury). * **Most common infectious risk:** Bacterial contamination (especially in **Platelets**, as they are stored at room temperature). * **Management of FNHTR:** Stop transfusion, rule out hemolysis, and administer antipyretics (Acetaminophen). [1] **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 673-674.

Q: Which of the following is best to confirm the diagnosis of thalassemia trait in a patient with a positive family history of thalassemia?

Elevated HbA2. **Explanation:** **1. Why Elevated HbA2 is the Correct Answer:** The hallmark of **Beta-Thalassemia Trait (Minor)** is a quantitative deficiency in beta-globin chain synthesis. To compensate for the lack of beta chains, there is a relative increase in delta-chain production, which combines with alpha chains to form **Hemoglobin A2 (α2δ2)**. * **Diagnostic Gold Standard:** High-Performance Liquid Chromatography (HPLC) or Hemoglobin Electrophoresis is used to quantify Hb levels. * **Cut-off:** An **HbA2 level >3.5%** is considered diagnostic for Beta-Thalassemia Trait. HbF may also be slightly elevated (1–5%), but HbA2 is the more reliable confirmatory marker. **2. Why Other Options are Incorrect:** * **NESTROFT (Naked Eye Single Tube Red Cell Osmotic Fragility Test):** This is a highly sensitive **screening test** used in field surveys and mass screenings due to its low cost. However, it is not confirmatory as it can be positive in other conditions like iron deficiency anemia (IDA). * **Peripheral Smear:** While it shows characteristic microcytic hypochromic cells, target cells, and basophilic stippling, these findings are non-specific and overlap significantly with IDA. * **Reticulocytosis:** In thalassemia trait, the reticulocyte count is usually normal or only slightly elevated. Significant reticulocytosis is more characteristic of Thalassemia Major or Intermedia. **3. NEET-PG Clinical Pearls:** * **Mentzer Index:** (MCV/RBC count). If ** 13**, it suggests Iron Deficiency Anemia. * **RBC Count:** In Thalassemia trait, the RBC count is typically **elevated** (polycythemia) despite low hemoglobin, whereas in IDA, the RBC count is low. * **Differential Diagnosis:** Always rule out IDA before diagnosing Thalassemia trait, as iron deficiency can falsely lower HbA2 levels, potentially masking a Thalassemia diagnosis.

Q: Which anticoagulant is used in coagulation studies?

Trisodium citrate. **Explanation:** **Trisodium citrate (3.2%)** is the anticoagulant of choice for coagulation studies (PT, APTT, and Fibrinogen levels). It works by **chelating calcium ions**, which are essential cofactors in the coagulation cascade. It is preferred because its action is easily reversible by adding calcium back to the plasma during testing. For accurate results, a precise **blood-to-anticoagulant ratio of 9:1** must be maintained; underfilling the tube leads to excess citrate, which falsely prolongs clotting times [1]. **Why other options are incorrect:** * **EDTA (Ethylenediaminetetraacetic acid):** While it is a potent calcium chelator, it is unsuitable for coagulation studies because it irreversibly inhibits certain clotting factors (like Factor V and VIII) and interferes with the end-point detection of fibrin formation. It is primarily used for CBC and peripheral smears. * **Calcium citrate:** This is not an anticoagulant; in fact, adding calcium to citrated plasma is the standard way to initiate the clotting process in a laboratory setting. * **Sodium bromide:** This has no role as a clinical anticoagulant. Historically, bromides were used as sedatives or antiepileptics. **High-Yield Clinical Pearls for NEET-PG:** * **Tube Color:** Trisodium citrate is found in the **Light Blue** top tube. * **Concentration:** 3.2% (0.109 mol/L) is the standard recommendation by the CLSI. * **Polycythemia Correction:** If a patient’s hematocrit is **>55%**, the volume of citrate must be adjusted (decreased) because there is less plasma relative to the anticoagulant, which can cause falsely elevated PT/APTT [1]. * **Platelet Function:** Citrate is also used for Platelet Aggregation Studies. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 625-626.

Question 1

Atypical lymphocytosis is most likely to be found in which one of the following diseases?

Accepted Answer

Infectious mononucleosis induced by Epstein-Barr virus

Answer

Encephalitis caused by herpes simplex virus (HSV)

Answer

Parvovirus infection

Answer

Chronic hepatitis C

Question 2

Which of the following is a common blood transfusion reaction?

Accepted Answer

Febrile nonhemolytic transfusion reaction

Answer

Hemolysis

Answer

Transmission of infections

Answer

Electrolyte imbalance

Question 3

The diagnostic triad of exophthalmos, diabetes insipidus, and bone lesions is characteristic of which condition?

Accepted Answer

Hand-Schuller Christian disease

Answer

Fibrous dysplasia

Answer

Letterer-Sieve disease

Answer

Osteoporosis

Question 4

Which of the following is best to confirm the diagnosis of thalassemia trait in a patient with a positive family history of thalassemia?

Accepted Answer

Elevated HbA2

Answer

Reticulocytosis

Answer

NESTROFT

Answer

Peripheral smear

Question 5

A patient presents with splenomegaly, low RBC count, normal WBC and platelet count, and peripheral blood smear shows target cells. Repeated bone marrow aspiration is unsuccessful. What is the probable diagnosis?

Accepted Answer

Myelofibrosis

Answer

Thalassemia

Answer

Chronic myeloid leukemia

Answer

Iron deficiency anemia

Question 6

Which anticoagulant is used in coagulation studies?

Accepted Answer

Trisodium citrate

Answer

Calcium citrate

Answer

EDTA

Answer

Sodium bromide

Question 7

A 60-year-old male patient presents with complaints of weakness and abdominal pain. General physical examination reveals marked splenomegaly and moderate hepatomegaly. Histopathologic findings are suggestive of leukoerythroblastosis. What condition is this patient most likely suffering from?

Accepted Answer

Primary myelofibrosis

Answer

Intestinal infarction

Answer

Sickle cell anemia

Answer

Chronic myeloid leukemia

Question 8

Mean corpuscular hemoglobin concentration (MCHC) is normal in all of the following conditions except?

Accepted Answer

Iron deficiency anemia

Answer

Megaloblastic anemia

Answer

Hemolytic anemia

Answer

Aplastic anemia

Question 9

All of the following are true regarding G-6PD deficiency except?

Accepted Answer

Females are commonly affected

Answer

A recessive X-linked trait

Answer

Oxidative stress causes hemolysis

Answer

Protective against Plasmodium falciparum malariae

Question 10

A WBC count of more than 1,00,000 cells/cc of blood indicates which of the following?

Accepted Answer

Leukemia

Answer

Leukopenia

Answer

Leukoplakia

Answer

Leukocytosis

Hematopathology — MCQs

Hematopathology — MCQs

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