Hematopathology Practice Questions

Q: The above marked structures are seen in all except?

Thalassemia. ***Thalassemia*** - The spleen remains **functionally intact** in thalassemia and actively removes **Howell-Jolly bodies** from circulation. - Despite splenomegaly from hemolysis, splenic function is preserved, effectively culling nuclear remnants from RBCs. *Sickle cell anemia* - **Functional asplenia** develops due to repeated **sickling crises** causing splenic autoinfarction and fibrosis. - The damaged spleen cannot remove **Howell-Jolly bodies**, leading to their persistence in peripheral blood. *Liver cirrhosis* - Advanced cirrhosis causes **splenic dysfunction** and **hyposplenism** due to portal hypertension and compromised splenic blood flow. - The dysfunctional spleen fails to filter **Howell-Jolly bodies**, allowing them to remain in circulation. *Chronic myeloid leukemia (CML)* - **Leukemic cell infiltration** of the spleen impairs its normal filtering function and causes splenic dysfunction. - The compromised spleen cannot effectively remove **Howell-Jolly bodies** from the bloodstream.

Q: Cell of origin of hairy cell leukemia is?

B-cell. Hairy Cell Leukemia (HCL) is a rare, chronic lymphoproliferative disorder characterized by the proliferation of mature B-lymphocytes. **1. Why B-cell is correct:** The cell of origin in HCL is a **mature memory B-cell** (post-germinal center). These cells exhibit characteristic "hairy" cytoplasmic projections. They express pan-B-cell markers such as **CD19, CD20, and CD22**. Crucially, they also express highly specific markers like **CD103** (most specific), **CD11c, CD25, and Annexin A1**. Almost all cases (approx. 95%) harbor the **BRAF V600E mutation**, which is a key diagnostic feature. **2. Why other options are incorrect:** * **T-cell & NK-cell:** While some rare T-cell leukemias can mimic the morphology of HCL (e.g., T-cell prolymphocytic leukemia), HCL is strictly a B-cell malignancy. T-cell and NK-cell markers (like CD3, CD4, CD8, or CD56) are negative in HCL. * **Dendritic reticulum cell:** These are antigen-presenting cells found in lymphoid follicles. While they interact with B-cells, they are not the progenitors of HCL. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Triad:** Splenomegaly (often massive), Pancytopenia, and "Dry Tap" on bone marrow aspiration (due to increased reticulin fibrosis). * **Diagnosis:** TRAP (Tartrate-Resistant Acid Phosphatase) positive staining; "Fried egg appearance" on bone marrow biopsy. * **Treatment:** Cladribine (2-Chlorodeoxyadenosine) is the drug of choice. * **Key Association:** Increased risk of atypical mycobacterial infections (e.g., *Mycobacterium avium-intracellulare*).

Q: Popcorn cells are characteristic of which of the following hematological malignancies?

Hodgkin’s lymphoma. **Explanation:** **Popcorn cells** (also known as L&H cells—Lymphocytic and Histiocytic variants) are the hallmark diagnostic feature of **Nodular Lymphocyte Predominant Hodgkin Lymphoma (NLPHL)**, a specific subtype of Hodgkin’s Lymphoma [1]. These cells are characterized by large, multi-lobed nuclei resembling a kernel of popped corn, with inconspicuous nucleoli. Unlike the classic Reed-Sternberg (RS) cells found in other subtypes, popcorn cells are **CD20 positive** and CD15/CD30 negative [1]. **Analysis of Options:** * **Option A (Correct):** Popcorn cells are a variant of RS cells specific to NLPHL [1]. While classic Hodgkin Lymphoma features "Owl-eye" RS cells, NLPHL is unique for these "popcorn" variants. * **Option B:** Non-Hodgkin’s Lymphoma (NHL) consists of a diverse group of B-cell and T-cell malignancies (like Follicular or Diffuse Large B-cell Lymphoma) that do not typically feature popcorn cells. * **Option C:** Burkitt’s Lymphoma is characterized by a **"Starry-sky" appearance** on low power, consisting of medium-sized B-cells with high mitotic activity and tingible body macrophages. * **Option D:** Multiple Myeloma is a plasma cell dyscrasia characterized by "Clock-face" chromatin in plasma cells, Mott cells, and Flame cells, rather than popcorn cells. **High-Yield Clinical Pearls for NEET-PG:** * **Immunophenotype of Popcorn Cells:** CD20+, CD45+, but **CD15- and CD30-** (the opposite of classic Hodgkin Lymphoma). * **Classic RS Cell:** Binucleated with prominent eosinophilic nucleoli ("Owl-eye"). * **Lacunar Cells:** Characteristic of the **Nodular Sclerosis** subtype of Hodgkin Lymphoma. * **Mnemonic:** NLPHL = **N**egative for 15/30, **L**&H cells, **P**opcorn appearance. **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. 614-618.

Q: Which of the following is NOT a feature of hemolytic anemia?

Increased haptoglobin. ### Explanation In hemolytic anemia, the hallmark is the premature destruction of red blood cells (RBCs). This process leads to the release of free hemoglobin into the plasma [1]. **Why "Increased haptoglobin" is the correct answer:** Haptoglobin is a plasma protein produced by the liver whose primary function is to bind free hemoglobin to prevent oxidative damage and iron loss. In hemolytic states (especially intravascular hemolysis), large amounts of hemoglobin are released. Haptoglobin binds to this hemoglobin, and the resulting **haptoglobin-hemoglobin complex** is rapidly cleared by the reticuloendothelial system (liver). Consequently, serum **haptoglobin levels decrease** (often becoming undetectable), not increase. **Analysis of incorrect options:** * **A. Hemoglobinuria:** When the hemoglobin-binding capacity of haptoglobin is saturated, free hemoglobin is filtered by the renal glomeruli, appearing in the urine [1]. * **B. Jaundice:** Hemolysis leads to an increase in unconjugated bilirubin (a byproduct of heme breakdown). When this exceeds the liver's conjugating capacity, acholuric jaundice occurs. * **D. Hemosiderinuria:** This is a sign of chronic intravascular hemolysis. Iron from reabsorbed hemoglobin accumulates in renal tubular cells as hemosiderin; when these cells slough off into the urine, it is detected via Prussian blue staining [1]. **Clinical Pearls for NEET-PG:** * **Best initial test for hemolysis:** Peripheral blood smear (look for schistocytes or spherocytes) and Reticulocyte count (increased). * **Most specific biochemical marker for intravascular hemolysis:** Decreased serum haptoglobin. * **Markers of Hemolysis:** ↑ Indirect Bilirubin, ↑ LDH, ↑ Reticulocytes, ↓ Haptoglobin. * **Intravascular vs. Extravascular:** Hemoglobinuria and Hemosiderinuria are specific to **intravascular** hemolysis [1].

Question 1

The above marked structures are seen in all except?

Accepted Answer

Thalassemia

Answer

Sickle cell anemia

Answer

Liver cirrhosis

Answer

Chronic myeloid leukemia (CML)

Question 2

Cell of origin of hairy cell leukemia is?

Accepted Answer

B-cell

Answer

T-cell

Answer

NK-cell

Answer

Dendritic reticulum cell

Question 3

Popcorn cells are characteristic of which of the following hematological malignancies?

Accepted Answer

Hodgkin’s lymphoma

Answer

Non-Hodgkin's lymphoma

Answer

Burkitt’s lymphoma

Answer

Multiple myeloma

Question 4

Which of the following statements about acute hemolytic reactions is false?

Accepted Answer

Associated with fever, chills, and rigors.

Answer

Multi-organ failure can occur.

Answer

Intravascular hemolysis is typically observed.

Answer

Often mediated by complement activation.

Question 5

Radiological examination shows evidence of bone infarct in a child. Which of the following conditions may be responsible?

Accepted Answer

Sickle cell disease

Answer

Iron deficiency anemia

Answer

Thalassemia

Answer

Hereditary spherocytosis

Question 6

Which of the following is NOT typically seen in Disseminated Intravascular Coagulation (DIC)?

Accepted Answer

Normal Activated Partial Thromboplastin Time (APTT)

Answer

Decreased fibrinogen

Answer

Thrombocytopenia

Answer

Elevated Prothrombin Time (PT)

Question 7

Which of the following is NOT a feature of hemolytic anemia?

Accepted Answer

Increased haptoglobin

Answer

Hemoglobinuria

Answer

Jaundice

Answer

Hemosiderinuria

Question 8

Which of the following is NOT a laboratory finding in thalassemia major?

Accepted Answer

Normal ferritin level

Answer

Normal TIBC

Answer

Microcytic hypochromic anemia

Answer

High saturation percentage

Question 9

Low serum haptoglobin in hemolysis is masked by which of the following conditions?

Accepted Answer

Bile duct obstruction

Answer

Pregnancy

Answer

Liver disease

Answer

Malnutrition

Question 10

A 16-year-old girl presents with bowel obstruction. Laparotomy reveals markedly enlarged para-aortic lymph nodes. Biopsy of the lymph nodes exhibits a diffuse neoplastic infiltrate of small, round lymphocytes with a "starry sky" appearance on low power. The cytoplasm of some of the lymphocytes is vacuolated and fat stains are positive. What immunophenotypic or cytogenetic abnormality would you expect in the neoplastic cells?

Accepted Answer

t(8;14) translocation

Answer

Positive non-specific esterase stain

Answer

Positive specific esterase stain

Answer

Low leukocyte alkaline phosphatase score

Hematopathology — MCQs

Hematopathology — MCQs

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