Hematopathology Practice Questions

Q: Identify the cell.

Basophil. ***Basophil*** - The cell has **large, coarse, and dense basophilic (dark purple-blue) granules** in its cytoplasm, which often obscure the multi-lobed nucleus. - This characteristic appearance, with the **prominent dark granules that obscure the nucleus**, is distinctive of a **basophil** on a peripheral blood smear. - Basophils contain histamine and heparin, and their granules stain intensely with basic dyes. *Eosinophil* - Would have **bright red-orange granules** that are uniform in size and do NOT obscure the nucleus. - The nucleus is typically bilobed and clearly visible. *Neutrophil* - Would have a **multilobed nucleus** (2-5 lobes) that is clearly visible. - Contains fine, light pink or neutral-staining granules in the cytoplasm. - Most common white blood cell (50-70% of WBCs). *Monocyte* - Largest white blood cell with abundant **grayish-blue cytoplasm**. - Has a **kidney-shaped or horseshoe-shaped nucleus** that is clearly visible. - Lacks prominent granules. *Lymphocyte* - Small cell with a **large, round, dark-staining nucleus** that occupies most of the cell. - Scant cytoplasm, typically appearing as a thin rim around the nucleus. - No cytoplasmic granules.

Q: Identify the cell.

Monocyte. ***Monocyte*** - Monocytes are characterized by their **large size** (12-20 µm), **kidney-shaped or horseshoe-shaped nucleus**, and **abundant, often grayish-blue cytoplasm** with fine azurophilic granules [1]. - They are precursors to **macrophages** and play a crucial role in phagocytosis and antigen presentation [1]. *Eosinophil* - Eosinophils have a **bilobed nucleus** and prominent **red-orange granules** in their cytoplasm, which stain with eosin [1]. - They are primarily involved in allergic reactions and defense against **parasitic infections** [1]. *Basophil* - Basophils are characterized by a **lobed nucleus** often obscured by large, coarse, **dark purple-blue granules** that contain histamine and heparin [1]. - They are the least common granulocyte and are involved in **allergic and inflammatory responses** [1]. *Lymphocyte* - Lymphocytes are typically **smaller** than monocytes, with a **large, round, or slightly indented nucleus** that occupies most of the cell [1]. - Their cytoplasm is usually **scanty and pale blue**, often appearing as a thin rim around the nucleus [1]. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 578-580.

Q: A 65-year-old man presents with pancytopenia and dry tap on bone marrow aspiration. Peripheral smear is given. The diagnosis is:

Hairy cell leukemia. ***Hairy cell leukemia*** - **Pancytopenia** and **dry tap** on bone marrow aspiration are classic features of hairy cell leukemia due to extensive marrow fibrosis [1]. - The peripheral smear would show characteristic **hairy cells** with cytoplasmic projections, confirming the diagnosis [1]. *Myelophthisic anemia* - While it can cause **pancytopenia** and sometimes a dry tap, it's due to marrow infiltration by fibrosis, granulomas, or metastatic cancer. - The peripheral smear would show **leukoerythroblastosis** (immature myeloid and erythroid precursors) and **teardrop cells**, which are not the primary diagnostic feature here. *Aplastic anemia* - Presents with **pancytopenia** and a **dry tap** due to severely hypocellular bone marrow [3]. - However, the peripheral smear would typically show only a reduction in all cell lines without the presence of abnormal cells like hairy cells [3]. *Myelodysplastic syndrome* - Can cause **pancytopenia** but typically presents with a **hypercellular or normocellular marrow** with dysplastic features, not a dry tap due to fibrosis [2]. - The peripheral smear would show **dysplastic changes** in one or more cell lines, but not the specific hairy cells seen in this case [2]. **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, p. 612. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 613-614. [3] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 595-596.

Q: A 70-year-old man presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear shows presence of:

CLL. ***CLL*** - The presentation of **painless cervical lymphadenopathy**, progressive **pallor** (due to anemia), and **petechiae** (due to thrombocytopenia) in an elderly patient is highly suggestive of **Chronic Lymphocytic Leukemia (CLL)** [2]. - Peripheral smear in CLL typically shows a proliferation of mature-appearing **small lymphocytes** and characteristic **smudge cells** [1]. *Acute ITP* - Acute ITP is characterized by sudden onset of **thrombocytopenia** and bleeding, often following a viral infection, and is more common in children. - It does not typically present with **lymphadenopathy** or progressive pallor as a primary feature. *Chronic ITP* - Chronic ITP is characterized by isolated **thrombocytopenia** and bleeding symptoms, usually without lymphadenopathy or significant anemia unless bleeding is severe. - The presence of **lymphadenopathy** points away from isolated ITP and towards a systemic hematological malignancy. *Richter syndrome* - Richter syndrome is the transformation of CLL into a more aggressive lymphoma, most commonly **diffuse large B-cell lymphoma (DLBCL)**. - While it can present with rapidly enlarging lymph nodes and systemic symptoms, the initial presentation described (painless lymphadenopathy, progressive pallor, petechiae) is more typical of **untreated CLL** before transformation [2]. **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, p. 602. [2] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 612-613.

Q: The pattern of inheritance of the hematological disorder shown is:

X-linked recessive. ***X-linked recessive*** - This pattern is characterized by affected males, unaffected females who can be carriers, and the absence of male-to-male transmission [1]. - The disorder is passed from an affected father to all his daughters (who become carriers) and from a carrier mother to 50% of her sons (who are affected) and 50% of her daughters (who are carriers) [1]. *Autosomal recessive* - In this pattern, affected individuals typically have unaffected parents, and both males and females are affected equally. - The disorder often skips generations, and consanguinity increases the risk. *Autosomal dominant* - This pattern shows affected individuals in every generation, with affected individuals having at least one affected parent. - Both males and females are affected equally, and male-to-male transmission can occur. *X-linked dominant* - This pattern is characterized by affected fathers passing the trait to all their daughters but none of their sons. - Affected mothers have a 50% chance of passing the trait to each child, regardless of sex. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Genetic Disorders, p. 151.

Q: The image shows presence of:

Extravascular hemolysis. ***Extravascular hemolysis*** - The image likely depicts **spherocytes** or other red blood cell abnormalities characteristic of extravascular hemolysis, where red cells are destroyed in the **spleen** or **liver** [1]. - This process leads to increased **unconjugated bilirubin** and often **splenomegaly** [2]. *Intravascular hemolysis* - This type of hemolysis occurs within blood vessels, leading to the release of **hemoglobin** into the plasma [3]. - It is characterized by **hemoglobinemia**, **hemoglobinuria**, and decreased **haptoglobin**, which are not directly visible in a typical blood smear image [3]. *Myelophthisic anemia* - This condition results from the **replacement of bone marrow** by abnormal tissue, such as fibrosis, tumors, or granulomas. - It is characterized by **leukoerythroblastosis** (immature white and red blood cells in peripheral blood) and **teardrop cells**, which are not the primary feature suggested by the term "hemolysis." *Extramedullary hematopoiesis* - This refers to the formation of blood cells outside the bone marrow, typically in the **spleen** or **liver**. - While it can be a compensatory mechanism in severe anemias, including some hemolytic anemias, it is a process of blood cell production, not directly a type of hemolysis itself. **References:** [1] Cross SS. Underwood's Pathology: A Clinical Approach. 6th ed. Common Clinical Problems From Blood And Bone Marrow Disease, pp. 602-603. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, p. 640. [3] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Red Blood Cell and Bleeding Disorders, pp. 639-640.

Q: The following image shows presence of:

Ovalocytes/Elliptocytes. ***Ovalocytes/Elliptocytes*** - The image shows a predominance of **oval or elongated red blood cells**, which are characteristic of ovalocytes or elliptocytes - These cells have an **elliptical shape with a length-to-width ratio greater than 1.3:1** - Commonly seen in **hereditary elliptocytosis** (genetic defect in RBC membrane proteins like spectrin or protein 4.1) - Also found in **iron deficiency anemia, thalassemias, myelodysplastic syndromes**, and occasionally in normal individuals *Spherocytes* - These are **small, round RBCs lacking central pallor** due to loss of membrane surface area - Seen in **hereditary spherocytosis** and **autoimmune hemolytic anemia** - The image does not show spherical cells with absent central pallor *Acanthocytes* - These are **irregularly spiculated RBCs** with 3-12 projections of varying length distributed unevenly - Associated with **liver disease, abetalipoproteinemia**, and **neuroacanthocytosis** - The cells in the image are oval/elongated, not irregularly spiculated *Target cells* - Also called **codocytes**, these cells show a **central dense area surrounded by pale zone and peripheral rim of hemoglobin** (bull's-eye appearance) - Seen in **thalassemia, liver disease, hemoglobin C disease**, and **post-splenectomy** - The image does not demonstrate the characteristic target appearance *Schistocytes* - These are **fragmented RBCs (helmet cells, triangular cells)** resulting from mechanical damage - Characteristic of **microangiopathic hemolytic anemia (MAHA)**, including DIC, TTP, HUS - The cells shown are intact oval cells, not fragmented

Question 1

Identify the cell.

Accepted Answer

Basophil

Answer

Eosinophil

Answer

Neutrophil

Answer

Monocyte

Answer

Lymphocyte

Question 2

Identify the cell.

Accepted Answer

Monocyte

Answer

Eosinophil

Answer

Basophil

Answer

Lymphocyte

Answer

Neutrophil

Question 3

A 65-year-old man presents with pancytopenia and dry tap on bone marrow aspiration. Peripheral smear is given. The diagnosis is:

Accepted Answer

Hairy cell leukemia

Answer

Myelophthisic anemia

Answer

Aplastic anemia

Answer

Myelodysplastic syndrome

Answer

Chronic lymphocytic leukemia

Question 4

A 15-year-old patient presents with eczematous lesions for last 5 years. On physical examination, the lesions have progressed to present as plaques. Enlarged liver and spleen are noted with increased TLC. The peripheral smear was made. Clinical diagnosis is:

Accepted Answer

Peripheral T cell lymphoma

Answer

Immunoblastic lymphoma

Answer

DLBCL

Answer

Lymphoplasmacytic lymphoma

Answer

Hodgkin lymphoma

Question 5

The following bone marrow specimen is suggestive of diagnosis of:

Accepted Answer

Aplastic anemia

Answer

Pure red cell aplasia

Answer

Myelodysplasia

Answer

Normal marrow

Answer

Hairy cell leukemia

Question 6

A 70-year-old man presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear shows presence of:

Accepted Answer

CLL

Answer

Acute ITP

Answer

Chronic ITP

Answer

Richter syndrome

Answer

Hairy cell leukemia

Question 7

Which is correct about the cytogenetic translocation seen in peripheral smear of a 70-year-old man who presents with painless cervical lymphadenopathy with progressive pallor and petechiae on ankles. Peripheral smear is shown below:

Accepted Answer

t(2: 5)

Answer

t(14: 15)

Answer

t(9: 22)

Answer

t(1: 19)

Answer

t(11: 14)

Question 8

The pattern of inheritance of the hematological disorder shown is:

Accepted Answer

X-linked recessive

Answer

Autosomal dominant

Answer

Mitochondrial inheritance

Answer

Autosomal recessive

Answer

X-linked dominant

Question 9

The image shows presence of:

Accepted Answer

Extravascular hemolysis

Answer

Intravascular hemolysis

Answer

Myelophthisic anemia

Answer

Extramedullary hematopoiesis

Answer

Microangiopathic hemolytic anemia

Question 10

The following image shows presence of:

Accepted Answer

Ovalocytes/Elliptocytes

Answer

Spherocytes

Answer

Acanthocytes

Answer

Target cells

Answer

Schistocytes

Hematopathology — MCQs

Hematopathology — MCQs

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