Hematopathology Practice Questions

Q: Which of the following is NOT part of the triad of hairy cell leukemia?

Erythema nodosum. **Explanation:** Hairy Cell Leukemia (HCL) is a rare, chronic B-cell lymphoproliferative disorder characterized by the classic clinical triad of **Splenomegaly, Pancytopenia, and "Dry Tap" on bone marrow aspiration.** [1] 1. **Why Erythema Nodosum is correct:** Erythema nodosum is a form of panniculitis (inflammation of fat cells under the skin) associated with infections (Streptococcal, TB), Sarcoidosis, or Inflammatory Bowel Disease. It is **not** a feature of HCL. 2. **Why the other options are part of HCL:** * **Splenomegaly:** This is the most common physical finding (often massive) due to the infiltration of the red pulp by "hairy" cells [1]. Notably, lymphadenopathy is usually absent. * **Pancytopenia:** Resulting from bone marrow infiltration and splenic sequestration [1]. Monocytopenia is a highly specific hallmark of HCL. * **Hypercellular marrow (with fibrosis):** While the marrow is often hypercellular with a characteristic "fried egg" appearance (cells with abundant cytoplasm and distinct borders), the increased reticulin fibrosis leads to a **"Dry Tap"** during aspiration [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Morphology:** B-cells with hair-like cytoplasmic projections [1]. * **Cytochemistry:** **TRAP positive** (Tartrate-Resistant Acid Phosphatase). * **Immunophenotype:** Positive for **CD11c, CD25, CD103**, and CD123. * **Genetic Mutation:** **BRAF V600E** mutation is seen in almost all cases. * **Treatment:** Cladribine (2-CdA) is the drug of choice. * **Biopsy Finding:** "Fried egg" appearance in the bone marrow and "Beefy red" appearance of the spleen [1]. **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. 610-612.

Q: Peripheral smear of a neonate with ABO incompatibility typically shows which of the following?

Microspherocytes. **Explanation:** In **ABO Incompatibility**, the presence of **Microspherocytes** on a peripheral smear is a hallmark finding. This occurs because maternal IgG antibodies (anti-A or anti-B) cross the placenta and bind to the neonate’s RBCs. Splenic macrophages then "nibble" away portions of the antibody-coated RBC membrane. The cell loses surface area but retains its volume, forcing it to assume a spherical shape (spherocyte) which is smaller and lacks central pallor. **Analysis of Options:** * **A. Microspherocytes (Correct):** Characteristic of ABO incompatibility. Note that spherocytes are typically **absent** in Rh incompatibility, making this a key differentiating feature. * **B. Elliptocytes:** These are cigar-shaped cells seen in Hereditary Elliptocytosis or iron deficiency anemia, not immune-mediated hemolysis. * **C. Fragmented RBCs (Schistocytes):** These indicate microangiopathic hemolytic anemia (MAHA), such as DIC or HUS, caused by mechanical shearing of RBCs. * **D. Polychromasia:** While polychromasia (representing reticulocytosis) is seen in ABO incompatibility due to the bone marrow's response to hemolysis, it is a **non-specific** finding seen in any hemolytic state. Microspherocytes are the more specific diagnostic clue for ABO disease. **NEET-PG High-Yield Pearls:** 1. **ABO vs. Rh:** ABO incompatibility can occur in the **first pregnancy** (unlike Rh) because anti-A/B antibodies are naturally occurring. 2. **Direct Coombs Test (DCT):** In ABO incompatibility, the DCT is often **weakly positive or negative**, whereas in Rh incompatibility, it is strongly positive. 3. **Blood Groups:** Most commonly occurs when the mother is **O** and the baby is **A or B**. 4. **Clinical Presentation:** Usually presents as mild jaundice within the first 24 hours of life. Severe hydrops is rare compared to Rh disease.

Question 1

Which of the following features cannot be used to differentiate between Hodgkin's lymphoma and Non-Hodgkin's lymphoma?

Accepted Answer

Painless lymphadenopathy

Answer

Extranodal involvement

Answer

Contiguous spread

Answer

Localization to a particular group of lymph nodes

Question 2

Which of the following is NOT part of the triad of hairy cell leukemia?

Accepted Answer

Erythema nodosum

Answer

Splenomegaly

Answer

Pancytopenia

Answer

Hypercellular marrow

Question 3

Which of the following are common features of hemolytic anemia?

Accepted Answer

Decreased RBC life span, Unconjugated hyperbilirubinemia, Altered erythroid and myeloid ratio

Answer

Decreased RBC life span, Unconjugated hyperbilirubinemia, Bile salt and bile pigments in urine

Answer

Unconjugated hyperbilirubinemia, Bile salt and bile pigments in urine, Altered erythroid and myeloid ratio

Answer

Decreased RBC life span, Bile salt and bile pigments in urine, Altered erythroid and myeloid ratio

Question 4

Which of the following is NOT true regarding Langerhans Cell Histiocytosis (LCH)?

Accepted Answer

CD-68 positive

Answer

Papular trunk lesions with scaling and crusting

Answer

Ulcerative nodules on mucosa

Answer

Calvarial defect with map lesions and floating teeth

Question 5

A 12-year-old male presented with a history of recurrent nose bleeds, easy bruising, frequent muscle hematoma formation, and prolonged bleeding following trivial trauma. On examination, certain skin lesions were seen along with jaundice, splenomegaly, lymphadenopathy, and joint and skin laxity. Lab findings revealed normal PT, prolonged aPTT, reduced ristocetin cofactor activity, and a normal factor VIII assay, normal platelet count and size, and normal platelet granules. What is the most probable diagnosis of the above condition?

Accepted Answer

von Willebrand disease

Answer

Bernard-Soulier syndrome

Answer

Hemophilia A

Answer

Platelet function defect

Question 6

A normotensive patient with normal hemoglobin suffered massive blood loss. The following findings could be expected, except:

Accepted Answer

Increased PCV

Answer

Increased MCV

Answer

Thrombocytosis

Answer

Reticulocytosis

Question 7

A 42-year-old man sustained severe injuries in an automobile accident and is admitted to the intensive care unit. Examination of a peripheral blood smear on the 3rd day of admission reveals helmet cells, schistocytes, and decreased platelets. Which of the following is most strongly suggested by these findings?

Accepted Answer

Disseminated intravascular coagulation (DIC)

Answer

Autoimmune hemolysis

Answer

Hereditary spherocytosis

Answer

Megaloblastic anemia

Question 8

Which of the following is true about beta-thalassemia trait?

Accepted Answer

All of the above

Answer

Increased HbF

Answer

Increased HbA2

Answer

Microcytosis

Question 9

Histologic sections of the thymus that reveal reactive follicles with germinal centers are diagnostic of what condition?

Accepted Answer

Thymic hyperplasia

Answer

Acute inflammation

Answer

Chronic inflammation

Answer

Thymic hypoplasia

Question 10

Peripheral smear of a neonate with ABO incompatibility typically shows which of the following?

Accepted Answer

Microspherocytes

Answer

Elliptocytes

Answer

Fragmented RBCs

Answer

Polychromasia

Hematopathology — MCQs

Hematopathology — MCQs

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