Hematopathology Practice Questions

Q: All of the following are features of hemolytic anemia except?

Bilirubin in urine. **Explanation:** The core concept in hemolytic anemia is the premature destruction of Red Blood Cells (RBCs), leading to an increase in **unconjugated bilirubin** (indirect bilirubin) [1]. 1. **Why "Bilirubin in urine" is the correct answer (The Exception):** In hemolytic anemia, the liver is overwhelmed by the excess production of unconjugated bilirubin. However, unconjugated bilirubin is **lipid-soluble** and bound to albumin; it cannot pass through the glomerular basement membrane [1]. Therefore, it does not appear in the urine (**acholuric jaundice**). Bilirubinuria only occurs when there is an increase in *conjugated* (water-soluble) bilirubin, typically seen in obstructive jaundice or hepatitis. 2. **Analysis of Incorrect Options:** * **Decreased RBC life span:** This is the definition of hemolysis. Normal RBCs live ~120 days; in hemolytic anemia, this is significantly reduced [1]. * **Altered Erythroid to Myeloid (E:M) ratio:** Normally, the E:M ratio is 1:3 or 1:4. In hemolysis, the bone marrow compensates for RBC loss by undergoing **erythroid hyperplasia**, which reverses or alters this ratio (e.g., 1:1 or higher). * **Decreased Haptoglobin:** Haptoglobin is a plasma protein that binds free hemoglobin released from lysed RBCs. During intravascular hemolysis, haptoglobin levels drop significantly as it is consumed while clearing free hemoglobin. **NEET-PG High-Yield Pearls:** * **Urine Findings:** In hemolysis, urine contains increased **Urobilinogen** but **NO Bilirubin** [1]. * **Markers of Hemolysis:** ↑ Reticulocyte count, ↑ LDH (Lactate Dehydrogenase), ↓ Haptoglobin, and ↑ Indirect Bilirubin [1]. * **Schistocytes:** Presence on a peripheral smear indicates microangiopathic hemolytic anemia (MAHA).

Q: All of the following blood group systems are known to cause hemolytic disease of the fetus and newborn except?

Lewis. **Explanation:** Hemolytic Disease of the Fetus and Newborn (HDFN) occurs when maternal IgG antibodies cross the placenta and attack fetal red blood cells (RBCs) carrying the corresponding paternal antigen. **Why Lewis is the correct answer:** The Lewis blood group system (Le^a, Le^b) does not cause HDFN for two primary reasons: 1. **Antibody Type:** Lewis antibodies are typically **IgM**, which are large pentamers that cannot cross the placenta. 2. **Antigen Expression:** Lewis antigens are not intrinsic to the RBC membrane; they are adsorbed from the plasma. In fetuses and neonates, these antigens are poorly expressed on RBCs, making them "Lewis negative" at birth. Therefore, even if antibodies were present, there is no target on fetal cells. **Analysis of Incorrect Options:** * **Kell (Option A):** The anti-K antibody is the second most common cause of severe HDFN after RhD. It is unique because it causes hemolysis AND suppresses fetal erythropoiesis in the bone marrow. * **Duffy (Option B):** Anti-Fy^a and anti-Fy^b are IgG antibodies that can cross the placenta and cause mild to moderate HDFN. * **Kidd (Option C):** Anti-Jk^a and anti-Jk^b are IgG antibodies known to cause HDFN, though cases are usually mild. **NEET-PG High-Yield Pearls:** * **Most common cause of HDFN:** ABO incompatibility (usually mild). * **Most common cause of severe HDFN:** RhD incompatibility. * **Kell Sensitization:** Unlike Rh, Kell HDFN presents with lower bilirubin levels because it causes anemia via erythroid suppression rather than just hemolysis. * **"I" and "P" systems:** Like Lewis, these are typically IgM and do not cause HDFN.

Question 1

Raised aPTT is seen in all of the following bleeding disorders except?

Accepted Answer

Henoch-Schonlein purpura

Answer

Hemophilia A

Answer

Hemophilia B

Answer

Von-Willebrand disease

Question 2

What is the biochemical marker of lymphocytic leukemia?

Accepted Answer

Periodic acid-Schiff (PAS) stain

Answer

Enolase

Answer

Peroxidase

Answer

Choline esterase

Question 3

Cytogenetic studies in a 40-year-old woman with follicular lymphoma demonstrate a t(14;18) chromosomal translocation involving the bcl-2 gene. Constitutive expression of the protein encoded by the bcl-2 gene inhibits which of the following processes in this patient's transformed lymphocytes?

Accepted Answer

Apoptosis

Answer

DNA excision repair

Answer

G1-to-S cell cycle progression

Answer

Oxidative phosphorylation

Question 4

A 15-year-old boy presented with a one-day history of bleeding gums, subconjunctival bleed, and purpuric rash. Investigations revealed the following results: Hb-6.4 gm/dL, TLC-26,500/mm3, Platelet - 35,000 mm3, Prothrombin time-20 sec (control of 13 sec), Partial thromboplastin time-50 sec, and Fibrinogen 10 mg/dl. Peripheral smear was suggestive of acute myeloblastic leukemia. Which of the following is the most likely diagnosis?

Accepted Answer

Promyelocytic leukemia

Answer

Myeloblastic leukemia without maturation

Answer

Myeloblastic leukemia with maturation

Answer

Myelomonocytic leukemia

Question 5

Which functional test assesses primary hemostasis?

Accepted Answer

Bleeding time

Answer

Activated partial thromboplastin time

Answer

Platelet count

Answer

Prothrombin time

Question 6

All of the following are features of hemolytic anemia except?

Accepted Answer

Bilirubin in urine

Answer

Decreased RBC life span

Answer

Altered erythroid and myeloid ratio

Answer

Decreased haptoglobin

Question 7

A 56-year-old female presents with headache, dizziness, generalized itching (especially after hot showers), and intense burning in her hands and feet, which is relieved by aspirin. Physical examination reveals splenomegaly and elevated blood pressure. Laboratory findings include HB: 20.1 g/dl, Hematocrit: 60%, WBC: 15,800, Platelet count: 500,000, low EPO, SpO2: 98%, and increased LAP. The patient is positive for JAK2V617F mutation. Which of the following histopathology slides corresponds to this clinical condition?

Accepted Answer

None of the above.

Answer

Histopathology slide A

Answer

Histopathology slide B

Answer

Histopathology slide C

Question 8

Bone marrow in Amyloid Lightchain Amyloidosis shows which of the following features?

Accepted Answer

Bone marrow plasmacytosis

Answer

Granulomatous reaction

Answer

Fibrosis

Answer

Giant cell formation

Question 9

All of the following blood group systems are known to cause hemolytic disease of the fetus and newborn except?

Accepted Answer

Lewis

Answer

Kell

Answer

Duffy

Answer

Kidd

Question 10

What is the most common cause of beta thalassemia?

Accepted Answer

Mutations leading to aberrant RNA splicing.

Answer

Mutations lie within the β-globin promoter and lower the rate of β-globin gene transcription.

Answer

Mutations involve the coding regions of the β-globin gene.

Answer

All of the above are equally common.

Hematopathology — MCQs

Hematopathology — MCQs

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