Hematopathology Practice Questions

Q: In anemia due to lead poisoning, what will the bone marrow characteristically show?

Basophilic stippling. **Explanation:** **Correct Answer: D. Basophilic stippling** Lead poisoning (Plumbism) interferes with the activity of the enzyme **5'-nucleotidase**, which is responsible for the degradation of ribosomal RNA. This inhibition leads to the persistence of ribosomal RNA aggregates within the cytoplasm of erythrocytes, appearing as fine, blue granules known as **basophilic stippling**. While this is classically seen in the peripheral smear, it is a characteristic finding in the erythroid precursors of the bone marrow in lead-affected erythropoiesis. **Analysis of Incorrect Options:** * **A. Dwarf megakaryocyte (Micromegakaryocyte):** These are characteristic of **Myelodysplastic Syndromes (MDS)** and certain types of Myeloid Leukemias. They are not associated with lead toxicity. * **B. Ring sideroblasts:** While lead poisoning inhibits ferrochelatase (leading to iron accumulation in mitochondria), **Ring sideroblasts** are the hallmark of **Sideroblastic Anemia**. In the context of NEET-PG, if both are options, Basophilic Stippling is the more "characteristic" morphological finding for lead, whereas Ring Sideroblasts are more specific to MDS (RARS) or hereditary sideroblastic anemia. * **C. Pelger-Huet anomaly:** This refers to hyposegmented neutrophils (pince-nez appearance). It is seen in **MDS (Pseudo-Pelger Huet)** or as a benign autosomal dominant condition. **Clinical Pearls for NEET-PG:** * **Enzymes inhibited by Lead:** δ-aminolevulinic acid dehydratase (ALA-D) and Ferrochelatase. * **Clinical Signs:** Burtonian lines (lead lines on gums), wrist drop/foot drop (peripheral neuropathy), and colic [1]. * **Radiology:** "Lead lines" at the metaphysis of long bones in children [1]. * **Treatment:** Chelation therapy with Succimer (oral), Ca-EDTA, or British Anti-Lewisite (BAL). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 418-419.

Q: Duffy antigen is associated with which Cluster of Differentiation?

CD234. The **Duffy antigen**, also known as the Duffy Antigen Receptor for Chemokines (DARC), is a glycoprotein expressed on the surface of red blood cells (RBCs) and endothelial cells. In the Cluster of Differentiation (CD) nomenclature, it is designated as **CD234**. **1. Why CD234 is Correct:** CD234 acts as a multi-ligand receptor for various chemokines. Its primary clinical significance in hematopathology lies in its role as the portal of entry for **Plasmodium vivax** merozoites [1]. Individuals who are "Duffy-negative" (Fy a-b-) lack this receptor on their RBCs, providing them with natural resistance against *P. vivax* malaria. This phenotype is highly prevalent in West African populations. **2. Analysis of Incorrect Options:** * **CD123:** This is the **IL-3 receptor alpha chain**. It is a high-yield marker for **Blastic Plasmacytoid Dendritic Cell Neoplasm (BPDCN)** and is also expressed in Hairy Cell Leukemia. * **CD345 and CD456:** These are **distractor options**. The current CD nomenclature officially extends to approximately CD371. Numbers in the 300s and 400s are either recently assigned or do not exist in standard medical curricula, making them common "filler" options in competitive exams. **Clinical Pearls for NEET-PG:** * **Malaria Link:** Duffy-negative status protects against *P. vivax* but **not** *P. falciparum* [1]. * **Chemokine Sink:** CD234 on endothelial cells acts as a "sink" to clear inflammatory chemokines from circulation. * **Genetics:** The Duffy gene is located on **Chromosome 1**. * **Transfusion Medicine:** Anti-Fya and Anti-Fyb antibodies are clinically significant and can cause Delayed Hemolytic Transfusion Reactions (DHTR). **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Infectious Diseases, pp. 398-400.

Question 1

In anemia due to lead poisoning, what will the bone marrow characteristically show?

Accepted Answer

Basophilic stippling

Answer

Dwarf megakaryocyte

Answer

Ring sideroblasts

Answer

Pelger-Huet anomaly

Question 2

A 25-year-old asymptomatic female underwent a preoperative coagulation test. Her bleeding time (BT) is 3 minutes, prothrombin time (PT) is 15/14 seconds, activated partial thromboplastin time (aPTT) is 45/35 seconds, platelet count is 2.5 lac/mm3, and factor VIII levels were 60 IU/dL. She most likely has:

Accepted Answer

Factor VIII inhibitors

Answer

Factor IX deficiency

Answer

Von-Willebrands disease type III

Answer

Lupus anticoagulant

Question 3

All the following cause extravascular hemolysis except?

Accepted Answer

Blood transfusion reaction

Answer

Hereditary spherocytosis

Answer

Thalassemia

Answer

Autoimmune hemolytic anemia

Question 4

Splenosis means:

Accepted Answer

Rupture of spleen and distribution of its tissue on peritoneum

Answer

Infection of spleen

Answer

Presence of accessory spleen

Answer

Non-functioning spleen

Question 5

Neoplastic cells with multilobulated nuclei ('clover leaf' or flower cells) are seen in which of the following?

Accepted Answer

Adult T-cell leukemia (ATLL)

Answer

Diffuse large B cell lymphoma (DLBCL)

Answer

Anaplastic large cell lymphoma (ALCL)

Answer

Mycosis fungoides

Question 6

In Burkitt's lymphoma, which chromosomal translocation is typically seen?

Accepted Answer

t(8;14)

Answer

t(12;14)

Answer

t(4;8)

Answer

t(12;18)

Question 7

All are important laboratory features of hemolytic anemia, EXCEPT:

Accepted Answer

Normal AST

Answer

Elevated urobilinogen in stool

Answer

Reduced haptoglobin

Answer

Macrocytes in blood smear

Question 8

Duffy antigen is associated with which Cluster of Differentiation?

Accepted Answer

CD234

Answer

CD123

Answer

CD345

Answer

CD456

Question 9

A 63-year-old man presented with massive splenomegaly, lymphadenopathy, and a total leukocyte count of 17,000 per mm³. Flow cytometry showed CD23-negative and CD5-positive monoclonal B-cells with bright kappa positivity, comprising 80% of the peripheral blood lymphoid cells. What is the most likely diagnosis?

Accepted Answer

Mantle cell lymphoma

Answer

Splenic lymphoma with villous lymphocytes

Answer

Follicular lymphoma

Answer

Hairy cell leukemia

Question 10

Basophilic stippling is seen in which of the following cells?

Accepted Answer

RBCs

Answer

Eosinophils

Answer

Basophils

Answer

Neutrophils

Hematopathology — MCQs

Hematopathology — MCQs

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