Hematopathology Practice Questions

Q: The NESTROFT test is used in the screening of which condition?

Thalassemia. **Explanation:** **NESTROFT** (Naked Eye Single Tube Red Cell Osmotic Fragility Test) is a simple, cost-effective, and rapid screening tool used primarily for **Thalassemia Minor (Trait)**. **Why Thalassemia is Correct:** In Thalassemia, there is a defect in globin chain synthesis leading to **hypochromic microcytic** red blood cells [1]. These cells have a high surface-area-to-volume ratio, making them more resistant to hemolysis in hypotonic solutions compared to normal RBCs. In the NESTROFT test, blood is added to a 0.36% buffered saline solution. If the solution remains **turbid** (meaning the line behind the tube is not visible), the test is positive, indicating decreased osmotic fragility characteristic of Thalassemia. **Why Other Options are Incorrect:** * **Autoimmune Hemolytic Anemia:** This is characterized by antibody-mediated destruction; screening usually involves the Coombs test, not osmotic fragility. * **Spherocytosis:** Hereditary Spherocytosis is characterized by **increased** osmotic fragility (cells burst easily). While an Osmotic Fragility Test (OFT) is used for diagnosis, NESTROFT specifically screens for the *resistance* seen in Thalassemia. * **G6PD Deficiency:** This is an enzyme defect. Screening is done using the Fluorescent Spot Test or Methemoglobin Reduction Test. **Clinical Pearls for NEET-PG:** * **Sensitivity:** NESTROFT has a high sensitivity (approx. 95-98%) making it an ideal mass screening tool in resource-limited settings. * **Confirmatory Test:** A positive NESTROFT must be followed by **Hb Electrophoresis** or HPLC (showing HbA2 > 3.5%) for confirmation of Thalassemia Trait. * **Differential:** Iron Deficiency Anemia (IDA) can also show a positive NESTROFT, but the turbidity is usually less marked than in Thalassemia.

Q: Sézary-Lutzner cells are characteristic of which condition?

Mycosis fungoides. **Explanation:** **Sézary-Lutzner cells** are the hallmark cytological feature of **Mycosis Fungoides (MF)** and its leukemic variant, Sézary Syndrome. These are atypical T-helper cells (CD4+) characterized by a **cerebriform nucleus**—a nucleus with deep indentations and folding that resembles the surface of the brain. In MF, these cells infiltrate the epidermis, forming pathognomonic clusters known as **Pautrier’s microabscesses**. **Analysis of Options:** * **Mycosis Fungoides (Correct):** The most common primary cutaneous T-cell lymphoma. The presence of these malignant lymphocytes in the skin (and blood in Sézary Syndrome) is diagnostic. * **Anaplastic Large Cell Lymphoma (ALCL):** Characterized by "Hallmark cells" (kidney or horseshoe-shaped nuclei) and strong expression of CD30. * **Hairy Cell Leukemia:** A B-cell neoplasm characterized by "hairy" cytoplasmic projections and a positive TRAP (Tartrate-Resistant Acid Phosphatase) stain. * **Peripheral T-cell Lymphoma (PTCL):** A heterogeneous group of aggressive nodal lymphomas; while they are T-cell derived, they do not typically feature the classic cerebriform Sézary-Lutzner morphology. **High-Yield Clinical Pearls for NEET-PG:** * **Sézary Syndrome Triad:** Erythroderma (exfoliative dermatitis), generalized lymphadenopathy, and the presence of >1000/mm³ Sézary cells in the peripheral blood. * **Immunophenotype:** Typically **CD3+, CD4+, and CD8-**. * **Histology:** Look for "epidermotropism" (T-cells migrating into the epidermis without significant spongiosis). * **Staging:** MF progresses through three clinical stages: Patch $\rightarrow$ Plaque $\rightarrow$ Tumor.

Q: Fragmented RBCs, sliced by fibrin bands, seen in intravascular hemolysis, are known as which of the following?

Schistocytes. **Explanation:** The correct answer is **Schistocytes**. **Mechanism of Formation:** Schistocytes are fragmented red blood cells (RBCs) that result from mechanical trauma. In conditions involving **Microangiopathic Hemolytic Anemia (MAHA)**, the intravascular space is crisscrossed by fibrin strands (microthrombi). As RBCs circulate, they are literally "sliced" by these fibrin bands, leading to the loss of cell membrane and the formation of irregular, jagged fragments (helmet cells, triangular cells). **Analysis of Incorrect Options:** * **B. Spherocytes:** These are small, dark-staining RBCs lacking central pallor. They occur due to molecular defects in the cytoskeleton (Hereditary Spherocytosis) or partial phagocytosis of antibody-coated RBCs (Autoimmune Hemolytic Anemia). * **C. Leptocytes (Target Cells):** Also known as Codocytes, these have a "bullseye" appearance due to an increased surface area-to-volume ratio. They are typically seen in Thalassemia, Liver disease, and Post-splenectomy states. * **D. Burr cells (Echinocytes):** These are RBCs with short, evenly spaced blunt projections. They are most commonly associated with **Uremia**, pyruvate kinase deficiency, or as an artifact in stored blood. **High-Yield Clinical Pearls for NEET-PG:** * **Key Associations for Schistocytes:** DIC (Disseminated Intravascular Coagulation), TTP (Thrombotic Thrombocytopenic Purpura), HUS (Hemolytic Uremic Syndrome), and prosthetic heart valves. * **Diagnostic Triad of MAHA:** Anemia, Schistocytes on peripheral smear, and Thrombocytopenia. * **Bite Cells vs. Schistocytes:** Do not confuse them. Bite cells (degmacytes) are seen in **G6PD deficiency** due to splenic macrophages removing Heinz bodies.

Question 1

The NESTROFT test is used in the screening of which condition?

Accepted Answer

Thalassemia

Answer

Autoimmune hemolytic anemia

Answer

Spherocytosis

Answer

G6PD deficiency

Question 2

A four-year-old boy presented with a two-month history of abdominal pain and fever, a ten-day history of maculopapular rash, and three days of dry cough, dyspnea, and wheezing. On examination, the liver and spleen were enlarged, measuring 4 cm and 3 cm below the costal margin, respectively. His hemoglobin was 10.0 g/dL, platelet count was 3.7 x 10^5/µL, and total leukocyte count was 70 x 10^3/µL, with 80% eosinophils. Bone marrow examination revealed a cellular marrow with 45% blasts, 34% eosinophils, and eosinophilic precursors. The blasts stained negative for myeloperoxidase and non-specific esterase and were positive for CD19, CD10, CD22, and CD20. Which one of the following statements is not true about the disease?

Accepted Answer

Inv(16) is often detected in the blasts and the eosinophils.

Answer

Eosinophils are not part of the neoplastic clone.

Answer

t(5;14) rearrangement may be detected in the blasts.

Answer

Peripheral blood eosinophilia may normalize with chemotherapy.

Question 3

Which of the following is a poor prognostic factor in Acute Myeloid Leukemia (AML)?

Accepted Answer

Preceding Myelodysplastic Syndrome (MDS)

Answer

Inversion 16 (Inv 16)

Answer

Auer rods

Answer

Myelomonocytic leukemia (Type M4)

Question 4

Sézary-Lutzner cells are characteristic of which condition?

Accepted Answer

Mycosis fungoides

Answer

Anaplastic large cell lymphoma (ALCL)

Answer

Hairy cell leukemia

Answer

Peripheral T-cell lymphoma (PTCL)

Question 5

What is the earliest change observed in iron deficiency anemia?

Accepted Answer

Decreased serum ferritin

Answer

Decreased serum iron

Answer

Decreased TIBC

Answer

Decreased hemoglobin

Question 6

Presence of >10% plasma cells with no lytic lesion and M protein in serum is seen in?

Accepted Answer

Smoldering myeloma

Answer

Multiple myeloma

Answer

Monoclonal gammopathy of unknown significance

Answer

Non-secretory myeloma

Question 7

Fragmented RBCs, sliced by fibrin bands, seen in intravascular hemolysis, are known as which of the following?

Accepted Answer

Schistocytes

Answer

Spherocytes

Answer

Leptocytes

Answer

Burr cells

Question 8

P.N.H is associated with all of the following conditions, except?

Accepted Answer

Increased LAP scores

Answer

Aplastic anemia

Answer

Venous thrombosis

Answer

Iron deficiency anemia

Question 9

The HAM test is used to assess for which of the following?

Accepted Answer

G.P.I. anchor protein deficiency

Answer

Complement defect

Answer

Spectrin defect

Answer

Mannose binding protein deficiency

Question 10

Which of the following are the histological features of classical Hodgkin's disease?

Accepted Answer

Both neoplastic and non-neoplastic cells are seen

Answer

Mixed cellularity seen in the background

Answer

Neoplastic cells more than non-neoplastic cells

Answer

CD15 and CD34 are seen

Hematopathology — MCQs

Hematopathology — MCQs

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