MLT GlobeHematology: WBC disorders & leukemias – page 2
145 Hematology MCQs on WBC disorders & leukemias with answers and explanations.
A 16-year-old boy has breathlessness, a mediastinal mass and WBC 150 × 10^9/L with blasts that are cytoplasmic CD3+, CD7+ and TdT+. The most likely diagnosis is:
T-ALL typically affects adolescent males with a high WBC and a thymic (anterior mediastinal) mass; cCD3 with TdT confirms immature T-lineage blasts. Hodgkin lymphoma also causes mediastinal masses but not circulating TdT+ blasts.
A CLL patient develops a falling hemoglobin, spherocytes, raised bilirubin and reticulocytosis. The most useful next test is:
Warm autoimmune hemolytic anemia is a common complication of CLL; a positive DAT confirms immune hemolysis. Osmotic fragility shows spherocytes but does not separate immune from hereditary causes.
A man with known CLL for 8 years develops fever, weight loss, a rapidly growing lymph node and very high LDH. The most likely event is:
Richter transformation is the change of CLL into an aggressive lymphoma, usually DLBCL, with B symptoms, rapidly enlarging nodes and high LDH. The other disorders are not typical outcomes of CLL.
A urine sample from a suspected myeloma patient is tested for monoclonal free light chains. The recommended method is:
Electrophoresis with immunofixation identifies and types monoclonal light chains (Bence Jones protein). Dipstick protein pads mainly detect albumin and react poorly with light chains, and the classic heat test is insensitive.
The most common non-Hodgkin lymphoma in adults worldwide is:
Diffuse large B-cell lymphoma accounts for about one-third of adult NHL. Follicular lymphoma is the most common indolent type but is less frequent overall.
A gastric biopsy shows a low-grade extranodal marginal zone (MALT) lymphoma. Which infection is most strongly linked to it?
Chronic H. pylori gastritis drives gastric MALT lymphoma, and many early cases regress after eradication therapy. EBV is linked to Burkitt and Hodgkin lymphoma; HHV-8 to primary effusion lymphoma.
A tumor mass of myeloblasts found in the orbit or skin, sometimes before marrow involvement, is called:
Myeloid sarcoma (granulocytic sarcoma, chloroma) is an extramedullary mass of myeloid blasts and is treated as AML. A plasmacytoma is a mass of clonal plasma cells.
A dehydrated patient has hematocrit 0.55 L/L, normal red cell mass, normal EPO and no mutation. The best term is:
Loss of plasma volume raises the hematocrit without increasing red cell mass; correcting dehydration normalizes it. Secondary polycythemia has a true rise in red cell mass with high EPO.
In primary myelofibrosis, the degree of marrow fibrosis is graded using which stain?
Reticulin fibers are shown by silver stains and graded MF-0 to MF-3; trichrome shows collagen. Perls stain shows iron stores and ring sideroblasts.
Flow cytometry shows CD19+ B cells with kappa:lambda ratio of 12:1. This most suggests:
Normal B cells show a kappa:lambda ratio of about 1–2:1 (roughly 0.5–3); a strongly skewed ratio indicates light chain restriction and clonality. T-cell clonality is not assessed by light chains.
Lymphoblasts in ALL often show coarse 'block' positivity with which cytochemical stain?
PAS stains glycogen, which may appear as coarse blocks in lymphoblasts (and in erythroid precursors in erythroid neoplasms). MPO and Sudan black B are markers of myeloid lineage.
Infectious mononucleosis is caused by which virus?
Classic infectious mononucleosis is caused by Epstein-Barr virus, which infects B lymphocytes. The heterophile (Monospot) test supports the diagnosis.
Acute promyelocytic leukemia is characterized by which translocation?
APL carries t(15;17), which forms the PML::RARA fusion. t(9;22) is the Philadelphia chromosome, t(8;14) is typical of Burkitt lymphoma and t(14;18) of follicular lymphoma.
Bence Jones proteins found in the urine of myeloma patients are:
Bence Jones proteins are free kappa or lambda light chains made by the plasma cell clone. They are small enough to pass the glomerulus into urine.
Acute leukemia is best described as:
In acute leukemia, maturation is blocked and blasts build up quickly, crowding out normal blood cell production. A slow rise of mature lymphocytes describes CLL.
A total white cell count below the reference interval (for example 2.5 × 10^9/L in an adult) is called:
Leukopenia is a low total white cell count. Leukocytosis is a raised count, and a leukemoid reaction is a very high reactive count.
Lymphomas are malignancies that arise mainly in:
Lymphomas are cancers of lymphocytes that usually form masses in lymph nodes or other lymphoid tissue, unlike leukemias, which start in the marrow.
In multiple myeloma, the most common type of monoclonal immunoglobulin is:
IgG myeloma is the most common, followed by IgA. A monoclonal IgM usually points to Waldenström macroglobulinemia rather than myeloma.
'B symptoms' in lymphoma refer to:
B symptoms are unexplained fever, drenching night sweats and weight loss of more than 10% in 6 months. They matter for staging and prognosis.
The CD34 antigen on blasts is a marker of:
CD34 is found on hematopoietic stem and early progenitor cells and on many leukemic blasts. It is lost as cells mature.