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01. Anemias

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02. Myeloproliferative
Disorders

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03. MDS/MPD
04. Myelodysplastic Syndrome
05. Acute Myeloid Leukemia
06. Acute Lymphoblastic
Leukemia

07. Hodgkin and Non Hodgkin

lymphoma

08. Mature B Cell Neoplasms

09. Mature T Cell and NK Cell

neoplasms
10. Histiocytic and Dendritic
Cell Neoplasms
11. Mastocytosis
12. Immunodeficiency
Associated
Lymphoproliferative Disorders
13. Coagulation disorders
14. Platelet Disorders
15. Missellaneous Diseases
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1.AnsB
Heinzbodiesareredcellinclusionsthatareseenonly
afteraspecificvitalstain.
Theystainpalepinkorpurple,attachedtotheredcell
membrane.
Heinzbodiescannotbeseenonaroutinelystainedblood
film.
Heinzbodiesrepresentdenaturedhaemoglobin.
Theyarepresentwhenredcellshavebeenexposedto
oxidantstress(e.g.certaindrugs),inindividualswith
glucose6phosphatedehydrogenasedeficiencyand
unstablehaemoglobins.

ADhlebodyisasmall,weaklybasophilic
cytoplasmicinclusionthatiscomposedofendoplasmic
Inclusionsaresmallandusuallyplacedtowardsthe
peripheryofthecell.
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OccasionalDhlebodiesareseeninhealthypeople,
duringpregnancy.
Otherwisetheyindicateapathologicalprocess,suchas
infection,inflammation,burnsorother
tissuedamage.

TheAlderReillyanomalyisarareinherited
condition.

granulocyteshavegranuleswithabnormalstaining
characteristics.

Autosomalrecessiveinheritanceorasafeatureof
seriousinheriteddisordersincludingTay
Sachsdiseaseandmucopolysaccharidoses.

MucopolysaccharidosesincludeHunter'ssyndrome
andMaroteauxLamysyndrome.

ThePelgerHutanomalyisaharmlessinherited
conditionwithautosomaldominantinheritance.

Neutrophilswithacompletelynonsegmentednucleus

Affectedindividualsalsohavehypolobulated
eosinophils.

B.Heinzbodies
Infectionorexposuretooxidantscausesoxidationof
sulphydrylgroupsoftheglobinchains.
ThisleadstodenaturationofHaemoglobinand
formationofprecipitates(Heinzbodies)thatcan
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beseenwithinredcellsasdarkinclusion,whenthey
arestainedwithcresylviolet.Heinzbody
damagesthemembranetocauseintravascular
haemolysis.
Dohlebodiessmallroundorovalpalebluegrey
structures(decomposedribosomes)seenin
bacterialinfectioninneutrophils
HoweljollybodiesNuclearremnantsseeninRBCin
conditionslikepostsplenectomyand
preniciousanaemia.Numeroussuchcellscanbeseen
inconditionslikesteatorrhoeainwhich
thereissplenicatrophyandfolatedeficiency.
2.AnsC
Sicklingtestisascreeningtestforsicklecelldisease.
Sicklecelldiseaseincludessicklecellanaemiaand
sicklecelltrait.
Sicklingtestwillbepositiveforboth.
ConfirmatorydiagnosisisdonebyHaemoglobin
electrophoresis.
Insicklecellanaemiathereisonlyonebroadbandof
HbSandintraittherewillbe2bandsAandS.
EventhoughHaemolysisispredominantly
extravascularspleenwillbecontractedbecauseof
repeatedinfarction.Prenataldiagnosisispossibleby
analysisoffoetalDNAobtainedby
amniocentesisorchronicbiopsy.

Dithionitetest.

Sodiummetabisulphitetest.

Hbsolubilitytest.

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4.AnsB

TCellLymphoma.
LymphoblasticLymphoma.
MycosisFungoides.
Anaplasticlargecelllymphoma.
HTLVtypeIleukemia/lymphoma.
Angioimmunoblasticlymphoma.
Hepatospleniclymphoma.
Lennertlymphoma.(Tcelllymphomawithgranuloma)

Workingformulations
REALclassification
WHOclassification

LowgradeSLL
Follicular
IntermediategradeFollicularlargecell
Diffuselargecell
HighgradeSmallnoncleaved
Lymphoblastic
Immunoblastic

5.D.MDSshowingdysplasticchangesinerythroid
,myeloidandmegakaryocyticcelllines.
RBCseriesshowingmegaloblasticnucleinuclear
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lobulation,fragmentation,internuclearchromatin
bridging.
Myeloidseriesshowingnuclearhyposegmentation,
pseudopelgerhuetanomaliesetc.
Megakaryocytesshowsbilobedornonlobulatednuclei.
AMLM6iscallederythroleukemia.

Anaemia&thrombocytopenia.
Leukopenia
Dyserythropoiesisnuclearlobulation
Fragmentation
Chromatinbridging
Dysmyelopoiesisaberrantdeficientgranule
production.
nuclearsegmentation
psudopelgerhuetanomaly

MyelodysplassticSyndromes
Type

Refractory

Percent

Survival

Patients

in
to
months
Leukemia(%)
(Median)

28

18

anemia
Rawith

12

64(50)
24

RS

1476+

(11)
RAEB

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Progression

23

716(11)

44

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RAEBt

26

2.511(5)

60

CMML

960(11)

14

6.AnsD
G6PDdeficiencycausesspherocytosis.
Allotherconditionsarecausesofmacrocytosis.
MacroOvalocyte
MacroPolycyte(HypersegmentedNeutrophil)
Dyserythropoiesis
Megaloblasts

7.AnsB
8.AnsAfragmentedcellsinuremia.
Seeninhemolyticuremicsyndrome.Synonyms
arehelmetcells.,triangularcells.Thin
redcellsareseeninsevereirondeficiency.or
thalassemia.Targetcellsareleptocytesinwhich
thereisacentralroundstainedarea.Targetcells
arethoughttoresultfromcellshavingasurface
areawhichisdisproportionatelylargecompared
withtheirvolume.
Drepanocytessicklecells
LeptocytesThinredcells

9.AnsA
10.AnsDALL.
pelgerhuetanomalyisabenigninherited
conditioninwhichneutrophilnucleifailto
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segmentproperly.Theyhave2discreteequal
sizedlobesconnectedbyathinchromatin.Similar
acquiredmorphologicalanomalyknownaspseudo
pelgercellsmaybeseeninMDS,AML,andrarelyin
CML.

11.AnsE.IMN
Allotherconditionsshowsincreaseinmonocytoid
cells.AMLM5(monoblasticleukemia).
IMNshowsabsolutelymphocytosiswithatypical
lymphocytes.(Downeytype)
12.AnsC
Chronicmylogenousleukaemia,blastphase
Blastphasemybediagnosedifoneormoreispresent

Blast>20%0fperipheralbloodwhitecellsorof
nucleatedbonemarrowcells

Extramedullaryblastproliferation
Largefociorclustersofblastsinthebonemarrow
biopsy

JuvenileChronicMyeloidLeukaemia

presentinearlychildhood.

Commonhaematologicalfeaturesareanaemia,

leucocytosis,monocytosisandthrombocytopenia.

Cytogeneticanalysisisusuallynormal.ThePh

chromosomeisnotpresent

Goingforacceleratedphase.
>20%Basophilia,fallinHb
Thrombocytopenia

13.AnsD
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TheBernardSouliersyndromeisaninherited
abnormalityofplateletnumberandfunction.Platelets
arereducedinnumberandverylarge.

Theylackthenormalaggregationresponsetoristocetin.
Thereisamoderatebleedingtendency.Inheritanceis
autosomalrecessive.

Thegreyplateletsyndromeisarareinherited
plateletabnormality.

Theplateletcountisreducedandplateletsizeis
increased.

Theplateletslackalphagranulesandtherefore
appearagranularor'grey'.

Theremaybeamildbleedingtendency.

D.Greyplateletsyndrome.
Characteristicmorphologicalfeaturesareseenintwo
inheritedplateletdisorders.
BernardSouliersyndromeGiantplateletswith
defectiveristocetinresponse.Herebleeding
resultingfromdefectiveadhesionofplateletsdueto
deficientglycoprotein1b.ThisisarecptorforVWF
factorandisessentialfornormalplateletadhesionto
collagen.
DefectiveplateletaggregationThrombasthenia(Def.
ofGPIIbIIIa)
ChediakHigashisyndrome.Herearegiantbutscanty
azurophilgranules,andalltheleucocytictypeswere
affected.Thereisfunctionaldefectandmanifestby
susceptibiltytosevereinfections.

14.AnsE.Masonfontanna.(Silverstaintodemonstrate
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melaninpigment)
Romanowskystainsmakesuttledistinctionsinshades
ofstainingandofstaininggranules
diffrentiallyanddependsontwocomponentsAzureB
andEosinY.

15.AnsD.Vonwillebrandsdisease
CharacterisedbyincreasedBTandnormalplatelet
count.TheplasmalevelofVWFcanbemeasuredas
ristocetincofactoractivityanditisreduced.VWF
stabilizesFVIIIbybindingtoit,sodeficiencyof
VWFgiverisetoasecondarydecreaseinFVIII
level.(increasedPTT)
Frequencyofvwd1%
Commoninheritedbleedingdisorder
AD.
TypeI(Mild70%),TypeII&III
Ristocetinaggregationtest
BioassayforVWF
Haemophilia
FVIIIDef.
BTNormal
PTTProlonged
16.AnsA
Panelofmonoclonalantibodiesfortheclassificationof
acuteleukaemias

Haematopoieticprecursors:CD34,HLA

Dr,TdT,CD452

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Blineage:CD19,CD20,CD22,CD79a1,3

Tlineage:CD2,CD31,CD5,CD7

Myeloid:CD13,CD33,CD15MPO1,CD117

Megakaryoblastic:CD41,CD61

.Nonspecificesterase.Sudanblackand
myeloperoxidasearestainsformyeloblastsandPAS
forlymphoblast.NSEformonocytesandTRAPfor
hairycellleukemia.
17.Ageby6years.

FavourablefactorsUnfavourable
factors
110yrs<1and>10
years
female
male
WBC<10,000/cmm>50,000/cmm
L1morphologyL2,L3
morpholgy
EarlyBcellprecursor(CALLA+ve)PreBcelltype
(CALLAve)

18.AnsB.AMLM3(promyelocyticleukemia)
Cytoplasmicgranulesliberatesprocoagualantsandthis
leadstoDIC.AMLM4presentwith
bleedingdisordersandgingivalhyperplasia.
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19.AnsC.3:1(Myeloideryhroidratio)
Normalvaluecanbevariedfrom2.515:1

20.AnsE
Classificationofaplasticanaemias

Inherited(e.g.Fanconisanaemia,
dyskeratosiscongenita)

Acquired
Druginduced
Doserelated(e.g.followingprolonged
useorexcessivedosageofcytotoxicdrugs)
Idiosyncratic(e.g.following
chloramphenicolorphenylbutazone)
Irradiationinduced
Virusinduced(e.g.followingnonA,nonB
hepatitis)
Immune(e.g.ingraftversushostdisease)
Idiopathic

CommonclinicalfeaturesofFanconi'sanaemia
Aplasticanaemiaandapredispositiontoacute
myeloidleukaemia
Reducedstature
Limbabnormalitiessuchasrudimentarythumbsand
radialhypoplasia.
Genitourinaryanomalies
Abnormalitiesofskinpigmentation

Commonclinicalfeaturesofdyskeratosiscongenita

Reticulateskinpigmentation
Dystrophyofnailsoffingersandtoes
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Mucosalleucoplakia
Anomaliesofothersystems(e.g.skeletal,dental,
ocular,gastrointestinal,genitourinary,pulmonary)

Progressivebonemarrowfailure
Predispositiontoepithelialtumours,e.g.of
gastrointestinaltract
.Presenceofnucleatedredcellsdenotespresenceof
youngerRBC
producion.Polychromasia/presenceofnormoblastsin
peripheralsmearisagainstadiagnosisofaplastic
anaemia.

21.AnsB.Trephinebiopsy.
Fromclinicalhistoryanaemia,neutropeniaand
thrombocytopeniasuggestaplastic
anaemia.Heremarrowspacesarereplacedbyfattissue
hencebonemarrowaspirationwillyieldonlyadrytap.

22.AnsB.Clottingtime

Thisisnothavinganydiagnosticimportance.

RepeatedCTestimationdoneduringheparintherapy
23.AnsCGenedeletion
thalassemiasareduetodefectsintranscription,
processingortranslationofmRNA

24.AnsE.Alloftheabove
Sequestrationcrisisoccursinchildrenwith
splenomegaly.Massivesequestrationofdeformedred
cellsleadstosplenicenlargmentandhypovolaemia
andshock.Aplasticcrisisisduetoparvovirus
infection.Venoocclusive(painfulcrisis)represents
episodesofhypoxicinjuryandinfarction.
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25.A.Spectrindeficiency
ThespheroidalshapeofRBCappearstoresultfroma
fundamentaldefectinthemembranecyto
skeleton(Spectrin)
Sicklecellanaemiaisduetopointmutation
substitutionofvalineforglutamicacidatthesixth
positionofchain.

Spherocyteshave

decreaseddiameter&SAtovolumeratio
Cellsbecomemorerigid&lessdeformable

Difficulttonegotiatethroughmicrocirculationin

spleen

REcellsrecognisesabnormalcellsanddestroys

them

IncreasedpermeabilitytoNa

MoreATPaseactivitytodriveNapump

Whenglucosesupplyislessduetohypoxiain

spleen

NafollowedbyH2Oenterthecell
Cellsswellandfinallyburst
Anautohaemolysistestinhereditaryspherocytosis.
Thereisincreasedhaemolysisinthepatientin
comparisonwiththecontrol.
Glucosehasgivenpartialcorrection.

26.AnsA
Warmautoimmunehaemolyticanaemia
Thebloodfilminthisconditionoccasionallyshows
smallredcellagglutinates

Warmautoimmunehaemolyticanaemiaisconsequent
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onthepresenceofanautoantibodywhichisactiveat
bodytemperature.
Itmayoccurasafeatureofanautoimmunedisease
suchassystemiclupuserythematosus,orasa
complicationofchroniclymphocyticleukaemia.
Itcanbeinducedbycertaindrugs,particularlya
methyldopa,andpersistsformanymonthsafter
withdrawalofthedrug.
Itcanoccurspontaneously,withoutanyother
associatedautoimmunedisease,whenitis
referredtoas'idiopathicwarmautoimmunehaemolytic
anaemia'.
Thedefinitivetestforautoimmunehaemolytic
anaemiainapatientwithspherocytosisisadirect
antiglobulintest(Coombs'test)whichtestsforantibody
andcomplementcomponentsonthesurfaceofthe
erythrocyte.
IgGtype.Itdoesnotfixthecomplementandisactive
at37C.Thediseaseisprimaryor
idiopathicorsecondaryduetolymphoma/leukemia.
ColdagglutinintypeIgMtypeactiveat04C.

Paroxysmalcold
haemoglobinuria
Bloodfilminparoxysmalcoldhaemoglobinuriashowing
spherocytes
anderythrophagocytosis.

Paroxysmalcoldhaemoglobinuria(PCH)occursasa
chronicconditionwithepisodichaemolysisandasan
acuteconditioninwhichthereisasingleepisodeof
haemolysis.Bothmaybeconsequentoncertain
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infections.Theacuteandchronicconditionshavein
commonthattheyresultfromthepresenceofan
autoantibodythatbindstoredcellsinthecoldwith
resultantredcelllysiswhenthecellsarerewarmed.A
testforthistypeofbiphasicantibodyactivityis
referredtoasaDonathLandsteinertestandthe
antibodyisdesignatedaDonathLandsteinerantibody.
Thedirectantiglobulintestmaybepositive.The
antibodyusuallyhasspecificityagainsttheredcellP
antigen.TheDonathLandsteinerantibodyisunusualin
thatitisanIgGantibodybutneverthelesscancausered
cellagglutination.

27.Ans.E
HbASsicklecelltrait(asymptomatic)
HbSSSicklecellanaemia(fatal)
HbH(thalessemia)deletionof3genes.Moderately
severedisease
HbBarts4(hydropsfoetalis)
HbSCseveredisease

28.A.FollicularBcelllymphoma
Bcl2geneistheprimeregulatorgeneforapoptosis.
SoBcl2overexpressioncanbe
demonstatedinmostoffollicularlymphomas.
t(1418)translocation

29.D.Sicklecellanaemia
Sincerouleauxformationisnotpossibledueto
defectiveshape,packingofredcellsdonotoccur.
MultiplemyelomashowsanextremelyincreasedESR.

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30.D.AnaemiaofCRF
InCRFerythropoietinproductionismarkedlyreduced
fromthekidneysoerythropoisesis
reduced.SoyoungerRBCsarenotseeninthe
circulation.Allotherconditionsshows
polychromaticcells.

31.A.Monocyte
Tartcellisamonocytewhichhasphagocytoseanother
cellornucleusofanothercell.The
phagocytosedmaterialresemblesalymphocyte
nucleus.Oftenassociatedwithleucoagglutininsand
mayoccurindrugtherapy.MorphologicallymimicLE
cells.

40.CutaneousTcellLymphoma
Mycosisfungoides
Pautriermicroabscess
epidermotropism
Sezarysyndrome
Convolutednucleus
46.Sicklecellgenefoundinmalariaendemicareas

Itgivesasurvivaladvantageovernormalpopulation

HbSpreventsmultiplicationofmalarialparasites

insidetheredcells

56.Lymphoplasmasmacyticlymphoma(wulden
stormmacroglobulinemia)
Plasmacytoidlymphocytesplymphocytes

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Russelbodiesimmunoglobulincollection
Dutcherbodiesnuclearinclusion
Motcellsmultiple,bluegrapelikecytoplasmic
droplets

57.HighgradelymphomaBurkitts
Lymphoblastic
Immunoblastic
Highmitosis
Highapototictumourcelldeath
58.C.AMLM3Promyelocyticleukemiat(15,17)
Translocationresultsinthefusionofatruncated
retinoicacidreceptor(RAR)geneo
chromosome17toPMLgeneonchromosome15.
PMLRARfusiongeneproducesahybridmRNA.
Thisencodesanabnormalretinoicacidreceptorwhich
blocksmyeloidcelldifferentiation

63.Ans.Counterpartoflymphoblasticlymphoma
64.HbA21.5to3%
Wifenormal(beta,beta)husbandbeta
minor(beta,beta+)
Recessivedisorder,Offspringswillbe2thalminorand
2normal.

68.Leadinterfereswiththesynthesisofheme.
Hemecausesmicrocytichypochromicanaemia
becausehemeisanintegralpartofhemoglobin

70.AnsA.Occursinimmunocompromised.Primaryis
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notdetectable.Usuallyaffectsonebodycavityinthe
formofpleural,percardialeffusions.

71.AnsD

72.AnsA.Phagocyticpolymorphonuclearcells,
granulesofwhichshowbrownianmovementsafranin
stain.
73.AnsC.Sedimentscontainingvarietyofcastand
otherpathologicalcomponents.
74.AnsB.Thecapacityofkidneytoconcentrateurine
islost.
75.AnsC.Eddiscountisaquantitativemeasurement
ofurinarysedimentsinagivenperiod
AnsC.Formalinisusedforsedimentexamination.
ConcentratedHclforchemicalexamination.
77.AnsA
78.AnsC
79.AnsC
81.AnsD
82.AnsD
83.AnsB
84.ans.B
85.Ans.D
86.Ans.A
87.Ans.B
88.Ans.C

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