MLT GlobeHematology: WBC disorders & leukemias – page 3
145 Hematology MCQs on WBC disorders & leukemias with answers and explanations.
Agranulocytosis refers to:
Agranulocytosis is a severe fall in neutrophils (granulocytes), often drug-induced. It carries a high risk of serious infection.
Which system is the current standard for classifying leukemias using morphology, immunophenotype and genetics together?
The WHO 5th edition integrates genetic, immunophenotypic and morphological data. FAB was morphology-only and is now historical; Rai stages CLL and Ann Arbor stages lymphoma.
Blasts containing bundles of Auer rods (faggot cells) are characteristic of which leukemia?
Auer rods are fused primary granules seen only in myeloid blasts; multiple rods in bundles typify APL with PML::RARA. Lymphoid leukemias never show Auer rods.
A lymph node biopsy shows large binucleate cells with prominent 'owl-eye' nucleoli in a mixed inflammatory background. What is the diagnosis?
Reed–Sternberg cells, large and binucleate with eosinophilic nucleoli, are the hallmark of classic Hodgkin lymphoma. They are typically CD15 and CD30 positive.
Which condition would NOT typically raise the eosinophil count?
Acute bacterial infections and stress raise cortisol, which lowers eosinophils. Allergy, helminths and Hodgkin lymphoma are recognized causes of eosinophilia.
Which of these conditions is recognized as a cause of eosinophilia?
Hodgkin lymphoma cells release IL-5 and other cytokines, raising eosinophils. Corticosteroids and acute sepsis lower eosinophils; tuberculosis is not a typical cause.
In Rai staging of CLL, a patient has absolute lymphocytosis only, without lymphadenopathy, organomegaly, anemia or thrombocytopenia. Which stage?
Rai stage 0 is lymphocytosis alone. Stage I adds enlarged nodes, II organomegaly, III anemia (Hb <11 g/dL) and IV thrombocytopenia (<100 × 10^9/L).
An asymptomatic patient is found to have early-stage CLL with stable blood counts. What is the usual management?
Early treatment does not improve survival in asymptomatic CLL. Therapy, now often BTK or BCL2 inhibitors, begins only when iwCLL criteria for active disease are met.
A patient has a WBC count of 80 × 10^9/L with all stages of granulocytes. A low neutrophil alkaline phosphatase score points to which diagnosis?
Neutrophils in CML have low LAP activity, whereas leukemoid reactions, infections and polycythemia vera show high LAP. BCR::ABL1 testing has now largely replaced the LAP score.
After treatment for acute leukemia, which method is most sensitive for detecting minimal residual disease?
PCR can detect about one leukemic cell in 10^5–10^6 normal cells, far better than morphology or karyotyping, allowing early detection of relapse.
A CLL patient has lymphocytosis and a platelet count of 70 × 10^9/L, whether or not nodes or spleen are enlarged. What is the Rai stage?
Thrombocytopenia below 100 × 10^9/L defines Rai stage IV regardless of other findings; anemia with Hb below 11 g/dL defines stage III.
Flow cytometry in CLL typically shows mature cells of which lineage co-expressing CD5 and CD23?
CLL is a clonal B-cell neoplasm expressing CD19, CD20 (weak), CD5 and CD23 with light chain restriction. CD5 is normally a T-cell marker.
Which pair of cytochemical stains usually give parallel results in myeloid blasts?
Sudan black B stains lipid in primary granule membranes, which contain MPO, so both are positive in myeloid blasts and negative in lymphoblasts.
Massive splenomegaly WITHOUT significant lymph node enlargement is most characteristic of:
CML typically enlarges the spleen, often massively, while lymphadenopathy is uncommon. ALL, lymphoma and disseminated TB usually involve lymph nodes as well as liver and spleen.
Apart from CML, the Philadelphia chromosome is found in a significant proportion of:
About a quarter of adult B-ALL cases carry t(9;22), usually producing p190, and it carries prognostic and treatment significance. It is not a feature of CLL or hairy cell leukemia, and ET is by definition BCR::ABL1-negative.
Which statement about the Philadelphia chromosome is correct?
The reciprocal translocation moves ABL1 onto BCR, leaving a small derivative 22. It arises in a stem cell, so lymphoid cells can carry it, and it also occurs in ALL.
Numerous smudge cells on a blood film from a patient with CLL are best explained by:
CLL cells are fragile and burst when spread on the slide. Adding albumin before spreading reduces smudging, which helps accurate differential counts.
First-line treatment for newly diagnosed chronic-phase CML is currently:
Tyrosine kinase inhibitors induce deep molecular responses in most patients. Allogeneic transplantation is now reserved for resistance or advanced phases; hydroxyurea only controls counts.
The genetic hallmark found in virtually all patients with CML is:
BCR::ABL1, detected by karyotype, FISH or PCR, defines CML. PML::RARA marks acute promyelocytic leukemia and JAK2 V617F the BCR::ABL1-negative MPNs.
In which disorder is the diagnosis most strongly suggested by the peripheral blood film alone?
CML shows marked leukocytosis with the full spectrum of myeloid cells, a myelocyte peak and basophilia. Lymphoma, myeloma and MDS usually need marrow, tissue or other tests.