Hematopathology Practice Questions

Q: Castleman disease is associated with which of the following?

Human Herpesvirus 8 (HHV-8). **Explanation:** **Castleman Disease (CD)**, also known as angiofollicular lymph node hyperplasia, is a rare lymphoproliferative disorder. The association with **Human Herpesvirus 8 (HHV-8)** is the cornerstone of its pathogenesis, particularly in the **Multicentric** variant (MCD). **Why HHV-8 is the correct answer:** HHV-8 (also known as Kaposi Sarcoma-associated Herpesvirus) encodes a viral homolog of **Interleukin-6 (vIL-6)**. This viral cytokine mimics human IL-6, driving B-cell proliferation, plasma cell differentiation, and systemic inflammation. This is especially prevalent in HIV-positive patients with MCD, where HHV-8 is found in nearly 100% of cases. **Why other options are incorrect:** * **HSV (A) & CMV (B):** While these are common herpesviruses, they are not etiologically linked to the pathogenesis of Castleman disease. CMV is more commonly associated with infectious mononucleosis-like syndromes or retinitis in immunocompromised states. * **EBV (C):** EBV is strongly associated with other lymphoid malignancies like Burkitt lymphoma, Hodgkin lymphoma, and Nasopharyngeal carcinoma, but it is not the primary driver of Castleman disease. **High-Yield Clinical Pearls for NEET-PG:** * **Histological Variants:** 1. **Hyaline-Vascular (80-90%):** Characterized by "Lollipop lesions" (sclerotic vessels entering germinal centers) and "Onion-skinning" of the mantle zone. Usually unicentric. 2. **Plasma Cell Variant:** Associated with systemic symptoms (fever, anemia) and elevated ESR due to IL-6. * **Clinical Association:** HHV-8 positive MCD is a significant risk factor for developing **Kaposi Sarcoma** and **Primary Effusion Lymphoma (PEL)**. * **Key Cytokine:** **IL-6** is the "master regulator" of the disease symptoms and progression.

Q: In iron deficiency anemia, which of the following are seen in a peripheral blood smear?

High TIBC, Low Ferritin. ### Explanation Iron Deficiency Anemia (IDA) is characterized by a depletion of total body iron stores, leading to impaired hemoglobin synthesis. To understand the biochemical markers, one must look at the body's compensatory mechanisms. **1. Why Option B is Correct:** * **Low Ferritin:** Ferritin is the primary storage form of iron in the liver and reticuloendothelial system. In IDA, these stores are the first to be depleted to maintain serum iron levels. Therefore, a **low serum ferritin** is the most specific initial laboratory finding for IDA. * **High TIBC (Total Iron Binding Capacity):** TIBC is an indirect measure of **Transferrin**, the protein that transports iron. When iron stores are low, the liver increases the synthesis of transferrin to maximize the capture of any available iron. Thus, TIBC increases as the body attempts to compensate for the deficiency. **2. Why Other Options are Incorrect:** * **Options A & C (Low TIBC):** A low TIBC is typically seen in **Anemia of Chronic Disease (ACD)** or iron overload states. In ACD, inflammatory cytokines (like Hepcidin) sequester iron and downregulate transferrin production. * **Options C & D (High Ferritin):** High ferritin levels indicate iron overload (Hemochromatosis) or an acute phase response (inflammation/infection), which contradicts a deficiency state. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Diagnosis:** Bone marrow aspiration showing absent stainable iron (Prussian Blue/Perl’s stain). * **Earliest Sign:** Decreased serum ferritin. * **Peripheral Smear:** Microcytic hypochromic RBCs with increased **RDW** (Red Cell Distribution Width), pencil cells, and occasional target cells [1]. * **Mentzer Index:** (MCV/RBC count) >13 suggests IDA, while <13 suggests Thalassemia trait. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 590-591.

Q: Acute hemolytic transfusion reactions are typically caused by antibodies directed against which of the following blood group antigens?

All of the above. **Explanation:** Acute Hemolytic Transfusion Reactions (AHTR) occur when a recipient’s pre-existing antibodies (IgM or IgG) attack the donor’s red blood cells (RBCs) immediately or within 24 hours of transfusion [2]. This leads to intravascular or extravascular hemolysis. **Why "All of the above" is correct:** While **ABO incompatibility** is the most common and severe cause of AHTR (due to naturally occurring IgM antibodies), antibodies against **minor blood group antigens** can also trigger these reactions [1]. * **Rh system (Option A):** Anti-D, Anti-C, or Anti-E antibodies are potent triggers for hemolysis [1]. * **Kell system (Option B):** The K antigen is highly immunogenic; anti-K antibodies are a frequent cause of severe hemolytic reactions. * **Duffy system (Option C):** Anti-Fya and Anti-Fyb antibodies are known to cause both acute and delayed hemolytic reactions. Since antibodies against Rh, Kell, and Duffy antigens are all clinically significant and capable of causing acute hemolysis, "All of the above" is the most accurate choice. **Clinical Pearls for NEET-PG:** * **Most Common Cause of AHTR:** Clerical error leading to ABO incompatibility [2]. * **Mechanism:** Type II Hypersensitivity reaction. * **Classic Triad:** Fever/chills, flank pain, and hemoglobinuria (red/dark urine). * **Delayed Hemolytic Transfusion Reaction (DHTR):** Most commonly associated with the **Kidd (Jk)** blood group system. * **Duffy Antigen & Malaria:** The Duffy antigen serves as a receptor for *Plasmodium vivax*. Individuals who are Duffy-negative (common in African populations) are resistant to *P. vivax* infection. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 627-628. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 673-674.

Question 1

Which of the following conditions is characterized by normal hemoglobin structure but reduced red blood cell volume?

Accepted Answer

Thalassemia

Answer

Chronic blood loss

Answer

Sickle cell anemia

Answer

Hemolytic anemia

Question 2

ADAMTS-13 is a metalloproteinase. It is produced by the:

Accepted Answer

Stellate cells in the liver

Answer

Alpha cells of the pancreas

Answer

Oligodendrocytes in the brain

Answer

Tubular epithelial cells of the kidney

Question 3

Giant platelets are seen in which of the following conditions?

Accepted Answer

Bernard-Soulier syndrome

Answer

Von Willebrand disease

Answer

Polycythemia rubra vera

Answer

Leukemia

Question 4

"Cabot" rings are characteristically seen in:

Accepted Answer

Post spleenectomy

Answer

Hemochromatosis

Answer

Thalassemia

Answer

Acquired hemolytic anemia

Question 5

Castleman disease is associated with which of the following?

Accepted Answer

Human Herpesvirus 8 (HHV-8)

Answer

Herpes Simplex Virus (HSV)

Answer

Cytomegalovirus (CMV)

Answer

Epstein-Barr Virus (EBV)

Question 6

Neutropenia is not a feature of which of the following conditions?

Accepted Answer

Congenital asplenia

Answer

Wiskott-Aldrich syndrome

Answer

Kostmann syndrome

Answer

X-linked hyper-IgM syndrome

Question 7

In iron deficiency anemia, which of the following are seen in a peripheral blood smear?

Accepted Answer

High TIBC, Low Ferritin

Answer

Low TIBC, Low Ferritin

Answer

Low TIBC, High Ferritin

Answer

High TIBC, High Ferritin

Question 8

A 14-year-old boy presents with gingival bleeding, oral ulcers, anemia, hepatomegaly, and no lymphadenopathy. His total leukocyte count is one lakh cells per mm³. What is the most likely diagnosis?

Accepted Answer

Acute myeloid leukemia

Answer

Chronic monocytic leukemia

Answer

Chronic lymphoblastic leukemia

Answer

Chronic myeloid leukemia

Question 9

Cryoprecipitate contains which of the following components?

Accepted Answer

Antithrombin

Answer

Fibrinogen

Answer

Factor VIII

Answer

Von Willebrand factor

Question 10

Acute hemolytic transfusion reactions are typically caused by antibodies directed against which of the following blood group antigens?

Accepted Answer

All of the above

Answer

Rh

Answer

Kell

Answer

Duffy

Hematopathology — MCQs

Hematopathology — MCQs

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