Haematology Exam 2025: MCQs on Anaemia, Leukaemia & Clotting

Question 1

A 28-year-old woman presents with fatigue and pallor. Complete blood count shows low haemoglobin level and peripheral blood film shows microcytic hypochromic red blood cells. What is the most likely diagnosis?

Accepted Answer

Iron deficiency anaemia — Microcytic hypochromic red cells are the classic morphological pattern of iron deficiency anaemia, reflecting impaired haemoglobin synthesis. ---

Question 2

The primary site of haematopoiesis in adults is

Accepted Answer

Bone marrow — After birth, the bone marrow (particularly axial skeleton) becomes the main site of blood cell production, replacing the fetal liver and spleen. ---

Question 3

Which blood cell type is primarily responsible for defence against parasitic infections?

Accepted Answer

Eosinophils — Eosinophils release cytotoxic granule proteins effective against helminths and other parasites, and are typically elevated in parasitic infection. ---

Question 4

Which clotting factor is deficient in Haemophilia A?

Accepted Answer

Factor VIII — Haemophilia A is an X-linked deficiency of Factor VIII, causing prolonged APTT with normal PT. ---

Question 5

A patient presents with recurrent infections, petechiae, and anaemia. A bone marrow biopsy shows reduced cellularity. What is the most likely diagnosis?

Accepted Answer

Aplastic anaemia — Pancytopenia with a hypocellular marrow reflects failure of haematopoietic stem cells, defining aplastic anaemia. ---

Question 6

Haemopoiesis is the process of

Accepted Answer

Blood cell production — Haemopoiesis refers to the formation of all cellular blood components from haematopoietic stem cells. ---

Question 7

A 62-year-old man presents with fatigue, fever and bruising. His full blood count shows WCC 40 × 10⁹/L with 25% circulating blasts, Hb 90 g/L and platelets 50 × 10⁹/L. Which investigation is required to definitively diagnose acute myeloid leukaemia?

Accepted Answer

Bone marrow aspirate and trephine biopsy — Marrow examination with immunophenotyping and cytogenetics is required for definitive diagnosis and classification of AML. ---

Question 8

Which cytochemical stain is most useful to confirm lymphoblasts in suspected ALL?

Accepted Answer

Terminal deoxynucleotidyl transferase (TdT) — TdT is a nuclear enzyme expressed in immature lymphoid precursors, positive in the vast majority of ALL cases. ---

Question 9

A patient receiving chemotherapy shows a drop in neutrophil count. This condition is termed

Accepted Answer

Neutropenia — Neutropenia is defined as an abnormally low absolute neutrophil count, a common chemotherapy toxicity. ---

Question 10

Which chromosomal translocation is pathognomonic of chronic myeloid leukaemia?

Accepted Answer

t(9;22)(q34;q11) — This translocation creates the Philadelphia chromosome and BCR-ABL1 fusion gene, the molecular hallmark of CML. ---

Question 11

Thrombopoietin primarily regulates the production of

Accepted Answer

Platelets — Thrombopoietin stimulates megakaryocyte proliferation and maturation, driving platelet production. ---

Question 12

Which of the following is a stem cell marker used to identify haematopoietic stem cells?

Accepted Answer

CD34 — CD34 is expressed on haematopoietic stem and progenitor cells and is used clinically to enumerate and select stem cells for transplant. ---

Question 13

In a bone marrow biopsy of a patient with aplastic anaemia, you would expect to find

Accepted Answer

Fatty replacement and hypocellularity — Aplastic anaemia is characterised by marrow hypocellularity with replacement by fat, reflecting stem cell failure. ---

Question 14

Granulocyte colony-stimulating factor (G-CSF) is used clinically to

Accepted Answer

Promote neutrophil recovery after chemotherapy — G-CSF stimulates neutrophil precursor proliferation and maturation, shortening chemotherapy-induced neutropenia. ---

Question 15

A patient with Chronic Lymphoid Leukaemia develops a warm autoimmune haemolytic anaemia. Which test is essential to confirm this complication?

Accepted Answer

Direct antiglobulin (Coombs) test — The DAT detects antibody or complement bound directly to the patient's red cells, confirming autoimmune haemolysis. ---

Question 16

A 25-year-old woman presents with painless cervical lymphadenopathy and night sweats. Excisional lymph node biopsy shows large binucleated cells expressing CD15 and CD30. What is the most likely diagnosis?

Accepted Answer

Classical Hodgkin lymphoma — Binucleated Reed-Sternberg cells expressing CD15 and CD30 are the diagnostic hallmark of classical Hodgkin lymphoma. ---

Question 17

A 60-year-old man on warfarin therapy for atrial fibrillation attends clinic for monitoring. His prothrombin time is 30 seconds (normal 11–15s) and his APTT is within normal limits. Which test is used to standardise his anticoagulant dose?

Accepted Answer

Prothrombin time / international normalised ratio (PT/INR) — Warfarin affects the extrinsic pathway; the INR standardises PT results across laboratories for dose monitoring. ---

Question 18

Which of the following laboratory findings is typically associated with haemolytic anaemia?

Accepted Answer

Increased lactate dehydrogenase (LDH) — Red cell destruction releases intracellular LDH; haemolysis also raises reticulocytes and unconjugated bilirubin while haptoglobin falls. ---

Question 19

A patient with HIV has an absolute neutrophil count of 0.4 × 10⁹/L. Which pathogen poses the greatest risk with this degree of neutropenia?

Accepted Answer

Staphylococcus aureus — Severe neutropenia primarily predisposes to bacterial and fungal infections from endogenous flora, with S. aureus being a leading cause of neutropenic sepsis. ---

Question 20

A 25-year-old man of Mediterranean descent presents with mild anaemia and target cells on a blood film. What is the most likely diagnosis?

Accepted Answer

Thalassaemia trait — Target cells with mild anaemia in a person of Mediterranean origin are classic for thalassaemia trait. ---

Question 21

A patient with chronic atrophic gastritis is at risk of which type of anaemia?

Accepted Answer

Pernicious anaemia — Atrophic gastritis destroys parietal cells that produce intrinsic factor, impairing B12 absorption and causing pernicious anaemia. ---

Question 22

In thalassaemia major, anaemia is primarily caused by

Accepted Answer

Defective globin chain synthesis — Imbalanced globin chain production causes ineffective erythropoiesis and haemolysis of defective red cells. ---

Question 23

The erythrocyte sedimentation rate (ESR) in normal pregnancy is typically

Accepted Answer

Markedly elevated due to increased fibrinogen — Pregnancy increases plasma fibrinogen and other acute phase proteins, promoting red cell rouleaux and raising ESR. ---

Question 24

What is the universal donor blood group for red blood cell transfusion?

Accepted Answer

O negative — O negative red cells lack A, B, and D (Rh) antigens, making them compatible with recipients of any ABO/Rh type in emergencies. ---

Question 25

A patient presents with a blood transfusion reaction within 30 minutes, showing fever, chills, and hypotension. What is the most likely diagnosis?

Accepted Answer

Acute haemolytic transfusion reaction — Rapid onset fever, chills, and hypotension during transfusion suggest ABO incompatibility causing acute intravascular haemolysis, a medical emergency. ---

Question 26

Which of the following is used to prevent transfusion-associated graft-versus-host disease in immunocompromised patients?

Accepted Answer

Irradiation of blood products — Irradiation inactivates donor T-lymphocytes, preventing them from engrafting and attacking immunocompromised recipient tissue. ---

Question 27

Which of the following blood components is indicated in a patient with thrombocytopenia and active bleeding?

Accepted Answer

Platelet concentrate — Platelet concentrate directly replaces the deficient platelets responsible for bleeding in thrombocytopenia. ---

Question 28

Which infection is most commonly screened for in donated blood?

Accepted Answer

Hepatitis B — Hepatitis B is a mandatory transfusion-transmissible infection screened for in all blood donations, alongside HIV and Hepatitis C. ---

Question 29

A peripheral blood film from a patient with suspected AML shows numerous blasts. Which cytochemical stain is most specific for confirming a myeloid lineage?

Accepted Answer

Myeloperoxidase (MPO) — MPO positivity, often seen as Auer rods, is the most specific stain confirming myeloid differentiation in blasts. ---

Question 30

Which of the following transfusion reactions is associated with hypotension and respiratory distress due to donor antibodies against recipient leukocytes?

Accepted Answer

TRALI (Transfusion-Related Acute Lung Injury) — Donor anti-leukocyte antibodies activate recipient neutrophils in the pulmonary vasculature, causing acute lung injury with hypotension and respiratory distress. ---

Question 31

Why is group O blood not suitable for plasma transfusion in emergencies?

Accepted Answer

It contains anti-A and anti-B antibodies — Group O plasma contains both anti-A and anti-B antibodies, which would haemolyse A or B red cells in most recipients. ---

Question 32

A patient with liver failure is coagulopathic and actively bleeding. Which blood product is most appropriate?

Accepted Answer

Fresh frozen plasma — FFP replaces the full range of clotting factors that are deficient due to impaired hepatic synthesis in liver failure. ---

Question 33

How long after collection can CPDA-1 packed red blood cells typically be stored before transfusion?

Accepted Answer

42 days — CPDA-1 anticoagulant-preservative extends red cell storage to a maximum of 42 days under standard refrigeration. ---

Question 34

Which sample type is preferred for cytogenetic and molecular analysis in suspected ALL?

Accepted Answer

Bone marrow aspirate — Bone marrow aspirate provides an adequate, representative sample of leukaemic blasts for karyotyping and molecular testing. ---

Question 35

Which of the following is a known cause of aplastic anaemia?

Accepted Answer

Chloramphenicol use — Chloramphenicol is a classic drug cause of idiosyncratic bone marrow aplasia through direct toxicity to haematopoietic stem cells. ---

Question 36

Which diagnostic method is used to detect the Philadelphia chromosome in interphase cells?

Accepted Answer

Fluorescence in situ hybridisation (FISH) — FISH can detect the BCR-ABL1 fusion in non-dividing (interphase) cells, unlike conventional cytogenetics which requires metaphase cells. ---

Question 37

A 60-year-old with established CLL complains of headaches and blurred vision. Which diagnostic procedure is indicated to assess for central nervous system involvement?

Accepted Answer

Lumbar puncture with cerebrospinal fluid cytology — CSF cytology directly detects leukaemic cell infiltration of the central nervous system. ---

Question 38

Which procedure is the gold standard to obtain diagnostic tissue in suspected lymphoma?

Accepted Answer

Excisional lymph node biopsy — Complete node removal preserves architecture, essential for accurate lymphoma subtyping, unlike FNA which yields insufficient tissue. ---

Question 39

Which immunophenotypic marker is typically positive in follicular lymphoma?

Accepted Answer

CD10 — CD10 positivity reflects the germinal centre B-cell origin characteristic of follicular lymphoma. ---

Question 40

A 68-year-old man presents with bone pain, anaemia, and elevated total protein. Serum electrophoresis reveals a monoclonal spike. What is the most likely diagnosis?

Accepted Answer

Multiple myeloma — Bone pain, anaemia, and a monoclonal (M) protein spike are the classic triad pointing to multiple myeloma. ---

Question 41

Which of the following is a common clinical finding in multiple myeloma?

Accepted Answer

Lytic bone lesions — Osteoclast-activating factors from myeloma cells cause characteristic punched-out lytic lesions, unlike lymphomas/leukaemias which more often cause organomegaly. ---

Question 42

Bence Jones proteins in the urine are composed of

Accepted Answer

Kappa or lambda light chains — Bence Jones proteins are free monoclonal immunoglobulin light chains filtered into the urine in myeloma. ---

Question 43

A 55-year-old woman receives an unfractionated heparin infusion for a deep-vein thrombosis. Which test is most appropriate to monitor her anticoagulant effect?

Accepted Answer

Activated partial thromboplastin time (APTT) — Unfractionated heparin prolongs the intrinsic pathway, so APTT is the standard monitoring test for dose titration. ---

Question 44

In HIV-associated thrombocytopenia, autoantibodies are often directed against which platelet antigen?

Accepted Answer

Glycoprotein IIb/IIIa — As in classic immune thrombocytopenia, autoantibodies most commonly target the GPIIb/IIIa complex on the platelet surface. ---

Question 45

Which coagulation factor is most markedly increased during pregnancy?

Accepted Answer

Factor XI — Fibrinogen rises substantially in pregnancy as part of the physiological hypercoagulable state that protects against peripartum haemorrhage. ---

Question 46

Which of the following features distinguishes monoclonal gammopathy of undetermined significance (MGUS) from multiple myeloma?

Accepted Answer

Elevated M protein without end-organ damage — MGUS is defined by a monoclonal protein below myeloma-defining levels with no CRAB (calcium, renal, anaemia, bone) end-organ damage. ---

Question 47

In patients with AML, marked gingival hypertrophy and infiltration is most commonly associated with which FAB subtype?

Accepted Answer

M5 (acute monocytic leukaemia) — Monocytic subtypes infiltrate soft tissue and gums, making gum hypertrophy a classic finding in M5. ---

Question 48

Which immunophenotypic marker is most characteristic of T-cell ALL?

Accepted Answer

CD3 — CD3 is the pan T-cell marker used to identify T-lymphoblasts in T-cell ALL, in contrast to CD19/CD20 which mark B-cell lineage. ---

Question 49

A 55-year-old man presents with fatigue, weight loss and splenomegaly. His full blood count shows WCC 140 × 10⁹/L with marked neutrophilia, left shift and basophilia. Which investigation is required to confirm the diagnosis of chronic myeloid leukaemia?

Accepted Answer

Bone marrow aspirate and trephine biopsy with cytogenetic analysis — Marrow examination with cytogenetics confirms the Philadelphia chromosome, establishing the definitive CML diagnosis alongside molecular BCR-ABL testing. ---

Question 50

Which laboratory test is most widely used as a prognostic tumour marker in lymphoma?

Accepted Answer

Lactate dehydrogenase — Serum LDH reflects tumour burden and turnover and is incorporated into prognostic indices such as the International Prognostic Index for lymphoma. ---

Haematology Exam 2025: MCQs on Anaemia, Leukaemia & Clotting

Questions, Answers & Explanations