Hematopathology Practice Questions

Q: A 3-year-old child presented with progressive anemia, jaundice, and failure to thrive. On examination, pallor and splenomegaly are seen. Peripheral smear showed normoblasts and small round intensely stained red cells. What is the likely diagnosis?

Hereditary spherocytosis. ### Explanation **1. Why Hereditary Spherocytosis (HS) is Correct:** The clinical triad of **anemia, jaundice, and splenomegaly** in a young child strongly suggests a chronic hemolytic process. The definitive clue lies in the peripheral smear: **"small round intensely stained red cells"** are **Spherocytes**. These cells lack central pallor because they have lost their biconcave shape due to defects in RBC membrane proteins (most commonly **Ankyrin**, followed by Spectrin). The presence of **normoblasts** (nucleated RBCs) indicates a robust compensatory bone marrow response to hemolysis. **2. Why Other Options are Incorrect:** * **Thalassemia:** While it presents with anemia and splenomegaly, the peripheral smear typically shows **microcytic hypochromic** cells, target cells, and basophilic stippling, not spherocytes. * **Sickle Cell Anemia:** Characterized by **sickle-shaped cells** and Howell-Jolly bodies. Splenomegaly is usually seen only in early childhood; later, "autosplenectomy" occurs due to repeated infarcts. * **Vitamin B12 Deficiency:** This is a **megaloblastic anemia** (macrocytic). The smear would show macro-ovalocytes and hypersegmented neutrophils, not spherocytes or jaundice from hemolysis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Inheritance:** Most commonly Autosomal Dominant. * **Gold Standard Test:** Eosin-5-maleimide (EMA) binding test (Flow cytometry). * **Screening Test:** Osmotic Fragility Test (increased fragility). * **MCHC:** Characteristically **elevated** (>36 g/dL) due to relative dehydration of the cell. * **Complications:** Pigmented gallstones (calcium bilirubinate) and Aplastic crisis (associated with **Parvovirus B19**). * **Treatment of Choice:** Splenectomy (usually deferred until after age 5–6 to reduce sepsis risk).

Q: Which of the following features is shared in common between lymphocyte-rich and lymphocyte-predominant types of Hodgkin's lymphoma?

Good prognosis. **Explanation:** Both **Lymphocyte-Rich Hodgkin Lymphoma (LRHL)** and **Nodular Lymphocyte-Predominant Hodgkin Lymphoma (NLPHL)** are characterized by an excellent clinical outcome [1]. They typically present at early stages (Stage I or II) and have a very high cure rate, making **"Good prognosis"** the defining shared feature. **Analysis of Options:** * **A. Paucity of diagnostic Reed-Sternberg (RS) cells:** This is true for **LRHL**, where classic RS cells are rare against a background of small lymphocytes [2]. However, **NLPHL** does not contain "classic" RS cells at all; instead, it features **L&H (Lymphocytic and Histiocytic) cells**, also known as "Popcorn cells" [1]. * **B. EBV Association:** LRHL is associated with EBV in about 40% of cases. In contrast, **NLPHL is almost never associated with EBV** [1], making this a distinguishing factor rather than a shared one. * **C. CD20 Positivity:** This is the hallmark of **NLPHL** (Popcorn cells are CD20+, CD45+, but CD15- and CD30-) [1]. In **LRHL**, the RS cells follow the classic immunophenotype: **CD15+, CD30+, and CD20 negative**. **High-Yield Pearls for NEET-PG:** * **NLPHL** is now considered a distinct entity from Classic Hodgkin Lymphoma (CHL) due to its B-cell marker expression (CD20) [1]. * **LRHL** is a subtype of **Classic Hodgkin Lymphoma** but mimics NLPHL morphologically [2]. * **Popcorn cells (L&H cells)** = NLPHL [1]. * **Most common subtype** of HL = Nodular Sclerosis. * **Best prognosis** = NLPHL / LRHL; **Worst prognosis** = Lymphocyte Depleted. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Diseases of White Blood Cells, Lymph Nodes, Spleen, and Thymus, pp. 616-618. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Diseases Of The Urinary And Male Genital Tracts, pp. 559-560.

Question 1

Dohle bodies are seen in which of the following conditions?

Accepted Answer

Burns

Answer

Multiple myeloma

Answer

Waldenstrom macroglobulinemia

Answer

Lymphoma

Question 2

Splenic infarction is associated with which of the following conditions?

Accepted Answer

Infective endocarditis

Answer

Typhoid fever

Answer

Chronic myeloid leukemia

Answer

Paroxysmal nocturnal hemoglobinuria

Question 3

A 3-year-old child presented with progressive anemia, jaundice, and failure to thrive. On examination, pallor and splenomegaly are seen. Peripheral smear showed normoblasts and small round intensely stained red cells. What is the likely diagnosis?

Accepted Answer

Hereditary spherocytosis

Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Vitamin B12 deficiency anemia

Question 4

Reed Sternberg cells are characteristic of which type of cell?

Accepted Answer

B cells

Answer

T cells

Answer

Natural killer cells

Answer

All of the above

Question 5

All are true about iron deficiency anemia EXCEPT?

Accepted Answer

Presence of sideroblasts

Answer

Hypochromic microcytic red blood cells

Answer

Serum ferritin as a marker

Answer

Anisocytosis and poikilocytosis

Question 6

Which one of the following lymphomas is associated with HTLV-virus infection?

Accepted Answer

Adult T-cell leukemia and lymphoma

Answer

Burkitt's lymphoma

Answer

B-cell lymphoma

Answer

Hodgkin's disease

Question 7

Prognosis of lymphoma depends on all of the following except:

Accepted Answer

Associated symptoms

Answer

Number of lymph node sites

Answer

Tumour size

Answer

Tumour stage

Question 8

HbH disease is characterized by which of the following genetic defects?

Accepted Answer

Deletion of three alpha-globin genes

Answer

Deletion of three alpha-globin genes and one beta-globin gene

Answer

Deletion of two alpha-globin and two beta-globin genes

Answer

Deletion of four alpha-globin genes

Question 9

Which of the following features is shared in common between lymphocyte-rich and lymphocyte-predominant types of Hodgkin's lymphoma?

Accepted Answer

Good prognosis

Answer

Paucity of diagnostic Reed-Sternberg cells

Answer

Epstein-Barr virus (EBV) is associated

Answer

Reed-Sternberg cells are CD20 positive

Question 10

What is true about follicular lymphoma?

Accepted Answer

Lymphadenopathy is the most common presentation.

Answer

BCL-2 positive

Answer

CD5 positive

Answer

More common in females than males.

Hematopathology — MCQs

Hematopathology — MCQs

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