Hematopathology Practice Questions

Q: Which of the following does NOT cause sideroblastic anemia?

Mercury poisoning. **Explanation:** Sideroblastic anemia is characterized by the presence of **ringed sideroblasts** in the bone marrow, which are erythroblasts with iron-laden mitochondria encircling the nucleus. This occurs due to a failure to incorporate iron into protoporphyrin to form heme. **Why Mercury Poisoning is the Correct Answer:** While several heavy metals interfere with heme synthesis [1], **Lead poisoning** is the classic cause of sideroblastic anemia. **Mercury poisoning**, conversely, typically presents with neurological symptoms (tremors, erethism), renal failure, or acrodynia [2], but it does **not** characteristically cause sideroblastic anemia. **Analysis of Incorrect Options:** * **Isoniazid (INH):** This is a classic cause. INH is a Vitamin B6 (Pyridoxine) antagonist. Since Pyridoxine is a required cofactor for **ALAS (delta-aminolevulinic acid synthase)**, the rate-limiting enzyme in heme synthesis [1], its deficiency leads to sideroblastic changes. * **Chloramphenicol:** This antibiotic inhibits mitochondrial protein synthesis, interfering with the mitochondrial enzymes necessary for heme production. * **Myelodysplastic Syndrome (MDS):** Specifically, the subtype **RARS (Refractory Anemia with Ringed Sideroblasts)** is a common primary/acquired cause of sideroblastic anemia in the elderly due to mitochondrial DNA mutations. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Bone marrow examination with **Prussian Blue stain** showing $\geq 5$ siderotic granules covering $\geq 1/3$ of the nuclear circumference. * **Reversible Causes:** Alcohol (most common), Lead, INH, and Copper deficiency. * **Treatment:** For INH-induced cases, administer **Pyridoxine (B6)**. * **Blood Smear:** Look for **dimorphic anemia** (two populations of RBCs: microcytic and normocytic) and **Pappenheimer bodies**.

Q: Fresh Frozen Plasma (FFP) is stored at what temperature?

Below -25 degrees Celsius. ### Explanation **Correct Option: C (Below -25 degrees Celsius)** Fresh Frozen Plasma (FFP) is the liquid portion of whole blood that is separated and frozen within 8 hours of collection [1]. The primary goal of FFP storage is to preserve **labile coagulation factors**, specifically **Factor V and Factor VIII**. According to standard guidelines (including WHO and DGHS India), FFP must be stored at temperatures **below -25°C** to maintain a shelf life of up to **1 year**. If stored between -18°C and -25°C, the shelf life is reduced to 3 months [1]. **Analysis of Incorrect Options:** * **A & D (2-4°C and 2-10°C):** These are the storage temperature ranges for **Packed Red Blood Cells (PRBCs)** and Whole Blood [1]. At these temperatures, labile clotting factors in plasma degrade rapidly, rendering it ineffective for treating coagulopathies. * **B (0 to -25°C):** While FFP can be stored at -18°C, the standard "ideal" storage for maximum factor preservation and the specific threshold tested in competitive exams is "below -25°C." **High-Yield Clinical Pearls for NEET-PG:** * **Thawing:** FFP must be thawed at **30-37°C** in a water bath before use. Once thawed, it must be transfused within **24 hours** (stored at 2-6°C) to ensure factor activity. * **Indications:** Multiple coagulation factor deficiencies (e.g., Liver disease, DIC), Warfarin reversal, and TTP (Plasmapheresis). * **Dosage:** The standard dose is **10-15 mL/kg**. * **Cryoprecipitate:** Formed by thawing FFP at 4°C; it is rich in **Factor VIII, Fibrinogen, von Willebrand Factor, and Factor XIII**.

Q: Spot the diagnosis?

Megaloblastic anemia. ***Megaloblastic anemia*** - Characterized by **macro-ovalocytes** (large oval-shaped RBCs) and **hypersegmented neutrophils** (>5 nuclear lobes) on peripheral blood smear. - Results from **vitamin B12** or **folate deficiency**, leading to impaired DNA synthesis and abnormal cell morphology. *Thalassemia* - Shows **microcytic hypochromic** RBCs with **target cells** and **teardrop cells** on peripheral smear. - Caused by **globin chain synthesis defects**, not vitamin deficiencies, resulting in smaller cell size. *Dimorphic anemia* - Presents with a **mixed population** of both **microcytic** and **macrocytic** RBCs on the same smear. - Often seen in **combined deficiencies** (iron + B12/folate) or **sideroblastic anemia**, showing dual cell populations. *G6PD deficiency* - Demonstrates **bite cells** and **blister cells** during hemolytic crises triggered by oxidative stress. - **Heinz bodies** may be visible with special stains, representing precipitated hemoglobin within RBCs.

Q: Spur cells are seen in which of the following conditions?

None of the above. **Explanation:** The correct answer is **None of the above** because the options provided list conditions typically associated with **Burr cells (Echinocytes)** rather than **Spur cells (Acanthocytes)**. **1. Understanding the Difference:** * **Spur Cells (Acanthocytes):** These are RBCs with a few irregularly spaced, thorny projections of varying lengths. They result from an imbalance in membrane lipids (increased cholesterol-to-phospholipid ratio). They are classically seen in **Abetalipoproteinemia** and **Severe Liver Disease** (specifically "Spur Cell Anemia" in cirrhosis). * **Burr Cells (Echinocytes):** These are RBCs with multiple, short, blunt, and *uniformly* spaced projections. They are typically seen in **Uremia**, **Gastric Carcinoma**, and **Hepatocellular Carcinoma**. **2. Analysis of Options:** * **Option A (Uremia):** This is the classic association for **Burr cells**. The metabolic changes in renal failure alter the osmotic environment, leading to uniform crenation of the RBC membrane. * **Option B & C (HCC and Gastric Carcinoma):** Microangiopathic changes or metabolic disturbances in these malignancies frequently lead to the formation of **Burr cells**, not spur cells. **3. High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Burr Cells:** "**U**nder **G**raduate **H**ematology" (**U**remia, **G**astric Carcinoma, **H**CC/Liver disease). * **Mnemonic for Spur Cells:** "**A**canthocytes = **A**betalipoproteinemia." * **Key Distinction:** Burr cells are often reversible (can revert to normal shape in healthy plasma), whereas Spur cells are irreversible due to permanent membrane remodeling by the spleen.

Question 1

All of the following are B cell markers except?

Accepted Answer

CD 34

Answer

CD 22

Answer

CD 19

Answer

CD 20

Question 2

Which of the following does NOT cause sideroblastic anemia?

Accepted Answer

Mercury poisoning

Answer

Isoniazid (INH)

Answer

Chloramphenicol

Answer

Myelodysplastic syndrome

Question 3

Bleeding in Disseminated Intravascular Coagulation (DIC) is most closely related to which of the following?

Accepted Answer

Low serum fibrinogen level

Answer

Raised fibrin degradation products level in blood

Answer

Prolonged prothrombin time

Answer

Raised thrombin time

Question 4

Fresh Frozen Plasma (FFP) is stored at what temperature?

Accepted Answer

Below -25 degrees Celsius

Answer

2-4 degrees Celsius

Answer

0 to -25 degrees Celsius

Answer

2-10 degrees Celsius

Question 5

Which of the following conditions is characterized by CD5+ lymphocytes?

Accepted Answer

Mantle cell lymphoma

Answer

Hairy cell leukemia

Answer

Burkitt lymphoma

Answer

Follicular cell lymphoma

Question 6

Which laboratory determinations are most helpful in distinguishing iron deficiency anemia from anemia of chronic disease?

Accepted Answer

Serum ferritin

Answer

Erythrocyte: granulocyte ratio in bone marrow

Answer

Presence or absence of polychromatophilic target cells

Answer

Presence or absence of stippled erythrocytes

Question 7

Spot the diagnosis?

Accepted Answer

Megaloblastic anemia

Answer

Thalassemia

Answer

Dimorphic anemia

Answer

G6PD deficiency

Question 8

Spur cells are seen in which of the following conditions?

Accepted Answer

None of the above

Answer

Uremia

Answer

Hepatocellular carcinoma

Answer

Gastric carcinoma

Question 9

In which one of the following does the host factor show a bimodal incidence curve?

Accepted Answer

Hodgkin's lymphoma

Answer

Kaposi's sarcoma

Answer

Osteosarcoma

Answer

Lung cancer

Question 10

A 48-year-old woman complains of weakness, fatigue, and easy bruisability for 2 months. She had worked as a technician in a nuclear energy plant for 15 years and was involved in an accident during which she was exposed to considerable radiation. Physical examination reveals an enlarged liver and spleen. What disease is the likely cause of her condition?

Accepted Answer

Chronic myelogenous leukemia

Answer

Hairy cell leukemia

Answer

Metastatic carcinoma of the breast

Answer

Metastatic carcinoma of the stomach

Hematopathology — MCQs

Hematopathology — MCQs

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