10 clinical MCQs in Exam Hematology. A 28-year-old woman presents with fatigue and pallor. Complete blood count shows low haemo. Kenya, Africa and globa...
Q1. 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?
Answer: Iron deficiency anaemia
Explanation: Microcytic hypochromic red cells reflect impaired haemoglobin synthesis, classically caused by iron deficiency. Vitamin B12 deficiency instead causes macrocytic anaemia; the other options don't typically present with this cell morphology. ---
Q2. The primary site of haematopoiesis in adults is
Answer: Bone marrow
Explanation: In adults, active haematopoiesis is confined mainly to the marrow of axial bones (vertebrae, sternum, pelvis, ribs) and proximal long bones. The liver/spleen are only sites of haematopoiesis in fetal life or in pathological 'extramedullary' states. ---
Q3. Which blood cell type is primarily responsible for defence against parasitic infections?
Answer: Eosinophils
Explanation: Eosinophils contain cytotoxic granule proteins (e.g., major basic protein, eosinophil cationic protein) specifically effective against helminths and other parasites. ---
Q4. Which clotting factor is deficient in Haemophilia A?
Answer: Factor VIII
Explanation: Haemophilia A is an X-linked recessive deficiency of Factor VIII. (Haemophilia B, by contrast, is a deficiency of Factor IX.) ---
Q5. A patient presents with recurrent infections, petechiae, and anaemia. A bone marrow biopsy shows reduced cellularity. What is the most likely diagnosis?
Answer: Aplastic anaemia
Explanation: The triad of infections (low WBC), petechiae (low platelets), and anaemia (low RBC) reflects pancytopenia; combined with a hypocellular marrow, this is diagnostic of aplastic anaemia — failure of the marrow to produce blood cells of all lineages. ---
Q6. Haemopoiesis is the process of
Answer: Blood cell production
Explanation: Haemopoiesis (haematopoiesis) refers to the formation and development of all blood cellular components — red cells, white cells, and platelets — from haematopoietic stem cells. ---
Q7. 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?
Answer: Bone marrow aspirate and trephine biopsy
Explanation: Although the peripheral smear already shows circulating blasts, definitive diagnosis and subclassification of AML require bone marrow examination — combining morphology, cytochemistry, immunophenotyping, and cytogenetic/molecular analysis. ---
Q8. Which cytochemical stain is most useful to confirm lymphoblasts in suspected ALL?
Answer: Terminal deoxynucleotidyl transferase (TdT)
Explanation: TdT is a nuclear enzyme expressed in immature lymphoid precursors (both B- and T-lineage), making it a key marker confirming a lymphoblastic (rather than myeloid) leukaemia. MPO and Sudan Black B are myeloid markers instead. ---
Q9. A patient receiving chemotherapy shows a drop in neutrophil count. This condition is termed
Answer: Neutropenia
Explanation: Neutropenia is defined as an abnormally low absolute neutrophil count, a common and clinically significant side effect of myelosuppressive chemotherapy. ---
Q10. Which chromosomal translocation is pathognomonic of chronic myeloid leukaemia?
Answer: t(9;22)(q34;q11)
Explanation: This is the Philadelphia chromosome, producing the BCR-ABL fusion gene that defines CML. The other options are characteristic translocations of specific AML/ALL subtypes, not CML.