Hematopathology Practice Questions

Q: Acute promyelocytic leukaemia (AML - M3) includes which of the following subtypes?

Hyper granular and micro granular type. **Explanation:** Acute Promyelocytic Leukaemia (APL), classified as **AML-M3** in the FAB classification, is characterized by the malignant proliferation of promyelocytes [1]. Morphologically, APL is divided into two distinct subtypes based on the appearance of the cytoplasm: 1. **Hypergranular Type (Typical/Classic):** This is the most common form. The cells contain numerous coarse, azurophilic granules and characteristic **Auer rods**, often found in bundles called **"Faggot cells"** [1]. 2. **Microgranular Type (Hypogranular/M3v):** In this variant, the granules are so small and fine that they are often invisible under a light microscope, giving the cytoplasm a "dust-like" or clear appearance [1]. A key diagnostic feature is the **bilobed or reniform (kidney-shaped) nucleus**, which can sometimes be mistaken for monocytes (AML-M5) [1]. **Analysis of Options:** * **Option A & D:** While "hypogranular" is often used interchangeably with "microgranular" in clinical practice, the formal morphological classification specifically uses the term **Microgranular** to describe the M3 variant. * **Option B:** "Hypersegmented" refers to neutrophils in megaloblastic anemia, not the morphology of promyelocytes in APL. **High-Yield Clinical Pearls for NEET-PG:** * **Cytogenetics:** Strongly associated with **t(15;17)**, involving the *PML-RARA* fusion gene [1]. * **Complication:** High risk of **Disseminated Intravascular Coagulation (DIC)** due to the release of procoagulants from granules [1]. * **Treatment:** Highly responsive to **All-Trans Retinoic Acid (ATRA)** and Arsenic Trioxide, which induce differentiation of the blast cells. * **Immunophenotype:** Typically **CD34 negative** and **HLA-DR negative**, but strongly positive for MPO. **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. 620-622.

Q: A child presents with hypochromic microcytic anemia, with normal levels of free Erythrocyte Protoporphyrin. What is the most likely diagnosis?

Thalassemia. **Explanation:** The key to solving this question lies in understanding the heme synthesis pathway. **Free Erythrocyte Protoporphyrin (FEP)** is the precursor that combines with iron to form heme. If iron is unavailable or its utilization is blocked, FEP accumulates in the red blood cell. **1. Why Thalassemia is correct:** Thalassemia is a quantitative defect in **globin chain synthesis**, not heme synthesis. Since the machinery for producing protoporphyrin and the availability of iron are both normal, FEP levels remain **normal**. This is a classic biochemical marker used to differentiate Thalassemia from Iron Deficiency Anemia (IDA). **2. Why the other options are incorrect:** * **Iron Deficiency Anemia (IDA):** There is insufficient iron to bind with protoporphyrin. Consequently, "unbound" or Free Erythrocyte Protoporphyrin **increases**. * **Lead Toxicity:** Lead inhibits the enzyme *Ferrochelatase*, which prevents the insertion of iron into the protoporphyrin ring. This leads to a significant **increase** in FEP (specifically Zinc Protoporphyrin). * **Anemia of Chronic Disease (ACD):** Iron is trapped within macrophages (high ferritin) and is unavailable for erythropoiesis. Similar to IDA, the lack of available iron leads to **increased** FEP. **High-Yield Clinical Pearls for NEET-PG:** * **Mentzer Index:** (MCV/RBC count) 13 suggests IDA. * **RDW:** Usually normal in Thalassemia trait but increased in IDA. * **Confirmatory Test:** Hb Electrophoresis (showing increased HbA2 > 3.5%) is the gold standard for Beta-Thalassemia trait. * **FEP** is also increased in Sideroblastic anemia (except the X-linked ALAS2 deficiency subtype).

Q: Which of the following statements is true regarding single-donor platelet transfusion?

Equivalent to 6-8 units of random-donor platelets. **Explanation:** **1. Why Option A is Correct:** A Single-Donor Platelet (SDP) unit is prepared via apheresis from a single individual [1]. One unit of SDP typically contains $\geq 3 \times 10^{11}$ platelets. In contrast, a unit of Random-Donor Platelets (RDP) contains approximately $5.5 \times 10^{10}$ platelets. Therefore, one SDP unit provides a platelet yield equivalent to **6–8 units of RDP**. Clinically, one SDP unit is expected to raise the adult recipient's platelet count by 30,000–60,000/L. **2. Why the Other Options are Incorrect:** * **Option B:** Platelets must be stored at **room temperature (20–24C)** with continuous agitation to maintain viability and prevent "storage lesion." Storage at 2–6C (refrigeration) is reserved for Red Blood Cells and causes irreversible platelet dysfunction. * **Option C:** Platelets have a short shelf life of only **5 days** due to the risk of bacterial overgrowth at room temperature. * **Option D:** In modern transfusion medicine, leukodepletion is ideally performed **pre-storage** (at the blood bank) rather than at the bedside. Pre-storage leukoreduction is more efficient at preventing Febrile Non-Hemolytic Transfusion Reactions (FNHTR) and HLA alloimmunization. **3. High-Yield Clinical Pearls for NEET-PG:** * **Dose:** 1 unit of RDP increases platelet count by 5,000–10,000/L. * **Indication:** Prophylactic transfusion is generally indicated when the platelet count falls below **10,000/L** in stable patients. * **Advantage of SDP:** Reduced risk of HLA alloimmunization and lower risk of transfusion-transmitted infections (TTIs) due to limited donor exposure [1]. * **Contraindication:** Platelet transfusions are generally contraindicated in **TTP (Thrombotic Thrombocytopenic Purpura)** and **HIT (Heparin-Induced Thrombocytopenia)** as they may fuel the prothrombotic state.

Question 1

Acute promyelocytic leukaemia (AML - M3) includes which of the following subtypes?

Accepted Answer

Hyper granular and micro granular type

Answer

Hyper granular and hypo granular type

Answer

Hyper granular and hyper segmented

Answer

Hypo granular and micro granular type

Question 2

Which of the following laboratory tests is affected by platelet count?

Accepted Answer

Bleeding time

Answer

Prothrombin time

Answer

Partial thromboplastin time

Answer

Thrombin time

Question 3

Which of the following is NOT a method of hemoglobin estimation?

Accepted Answer

Wintrobe's method

Answer

Drabkin's method

Answer

Sahli's method

Answer

Spectrophotometric method

Question 4

A child presents with hypochromic microcytic anemia, with normal levels of free Erythrocyte Protoporphyrin. What is the most likely diagnosis?

Accepted Answer

Thalassemia

Answer

Iron deficiency anemia

Answer

Lead toxicity

Answer

Anemia of chronic disease

Question 5

In sickle cell crisis, bone pain is primarily due to which of the following mechanisms?

Accepted Answer

Bone infarction

Answer

Osteoporosis

Answer

Osteomalacia

Answer

Periosteal reaction

Question 6

Which of the following conditions is NOT typically associated with a lymphatic leukemoid reaction?

Accepted Answer

Lobar Pneumonia

Answer

Tuberculosis

Answer

Pertussis

Answer

Viral infections

Question 7

Which of the following statements is not true regarding Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL)?

Accepted Answer

Transformation to Richter syndrome is commonly seen.

Answer

The tumor cells are positive for CD5 and CD20.

Answer

ZAP-70 expression is a poor prognostic marker.

Answer

Proliferation centers in lymph nodes are pathognomonic.

Question 8

Post-transfusion hepatitis is most commonly associated with which component?

Accepted Answer

Packed red blood cells

Answer

Platelets

Answer

Whole blood

Answer

Albumin

Question 9

What is the most specific investigation in disseminated intravascular coagulation?

Accepted Answer

D-dimer assay

Answer

Bleeding time

Answer

Clotting time

Answer

Fibrinogen level

Question 10

Which of the following statements is true regarding single-donor platelet transfusion?

Accepted Answer

Equivalent to 6-8 units of random-donor platelets

Answer

Stored at 2-6 degrees Celsius

Answer

Has a shelf life of 10 days

Answer

Leukodepletion is performed at the bedside

Hematopathology — MCQs

Hematopathology — MCQs

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