Pyq from haematology of neet pg and inict
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Here is a comprehensive topic-wise compilation of high-yield Haematology PYQs from NEET PG and INI-CET, with answers and explanations:
HAEMATOLOGY PYQs - NEET PG & INI-CET (Topic-wise)
TOPIC 1: IRON DEFICIENCY ANAEMIA (IDA)
Q1. [NEET PG 2019] A 25-year-old woman presents with fatigue, pallor, and koilonychia. Her MCV is 68 fL. Serum ferritin is 6 ng/mL. Which of the following is the MOST appropriate initial investigation to confirm iron deficiency anaemia?
A) Bone marrow examination
B) Serum iron and TIBC
C) Serum ferritin
D) Peripheral smear
Answer: C - Serum ferritin
Explanation: Serum ferritin is the single best screening test for IDA. It is the earliest marker to fall in iron deficiency. Although serum iron + TIBC ratio (transferrin saturation) is also used, ferritin alone is most sensitive. Bone marrow iron stores remain the gold standard for diagnosis but are invasive. Koilonychia, microcytic hypochromic anaemia clinch the diagnosis clinically.
Q2. [NEET PG 2020] In iron deficiency anaemia, which of the following is the FIRST parameter to be affected?
A) Haemoglobin
B) MCV
C) Serum ferritin
D) Serum iron
Answer: C - Serum ferritin
Explanation: The sequence of changes in IDA:
- Serum ferritin falls (first)
- Serum iron falls, TIBC rises
- Red cell changes - microcytosis, hypochromia (MCV falls)
- Haemoglobin falls (last)
Q3. [INI-CET 2021] Pencil cells (elliptocytes) on peripheral smear are characteristically seen in:
A) Hereditary spherocytosis
B) Iron deficiency anaemia
C) Thalassaemia trait
D) Megaloblastic anaemia
Answer: B - Iron deficiency anaemia
Explanation: Pencil/cigar-shaped cells (elongated elliptocytes) are characteristic of IDA. They appear due to iron deficiency affecting haemoglobin synthesis. In hereditary spherocytosis, you see spherocytes. Thalassaemia shows target cells.
Q4. [NEET PG 2022] Which bone marrow finding is the GOLD STANDARD for diagnosis of iron deficiency anaemia?
A) Hypercellular marrow
B) Absent stainable iron (Perl's stain)
C) Ringed sideroblasts
D) Megaloblastic changes
Answer: B - Absent stainable iron (Perl's/Prussian blue stain)
Explanation: Perl's Prussian blue stain on bone marrow biopsy showing absent iron stores is the gold standard. This distinguishes true IDA from anaemia of chronic disease (where bone marrow iron is present/increased).
TOPIC 2: MEGALOBLASTIC ANAEMIA
Q5. [NEET PG 2018] A 60-year-old male presents with numbness in lower limbs, mild jaundice, and pallor. Peripheral smear shows macro-ovalocytes and hypersegmented neutrophils. The MOST likely diagnosis is:
A) Iron deficiency anaemia
B) Vitamin B12 deficiency
C) Thalassaemia major
D) Aplastic anaemia
Answer: B - Vitamin B12 deficiency
Explanation: Classic triad of megaloblastic anaemia: pallor + neurological features (subacute combined degeneration - numbness) + mild jaundice (ineffective erythropoiesis). Macro-ovalocytes + hypersegmented neutrophils (>5 lobes in >5% of neutrophils or any neutrophil with 6+ lobes) are pathognomonic. Folate deficiency causes identical blood picture but WITHOUT neurological manifestations.
Q6. [INI-CET 2022] The minimum number of lobes in a neutrophil to call it hypersegmented is:
A) 4
B) 5
C) 6
D) 7
Answer: B - 5 lobes
Explanation: A neutrophil with 5 or more lobes is called hypersegmented. Finding >5% neutrophils with ≥5 lobes OR any neutrophil with ≥6 lobes is diagnostic of megaloblastic anaemia.
Q7. [NEET PG 2021] Which of the following is seen in Vitamin B12 deficiency but NOT folate deficiency?
A) Macro-ovalocytes
B) Hypersegmented neutrophils
C) Subacute combined degeneration of spinal cord
D) High serum homocysteine
Answer: C - Subacute combined degeneration of spinal cord
Explanation: Both B12 and folate deficiency cause megaloblastic anaemia with identical peripheral smear findings. Only B12 deficiency causes neurological manifestations (SACD) because B12 (but not folate) is required for myelin synthesis via methylmalonyl CoA pathway.
Q8. [INI-CET 2023] Schilling test is used to diagnose:
A) Iron deficiency anaemia
B) Pernicious anaemia / B12 malabsorption
C) Thalassaemia
D) G6PD deficiency
Answer: B - Pernicious anaemia / B12 malabsorption
Explanation: Schilling test assesses B12 absorption. It distinguishes dietary B12 deficiency from malabsorption (pernicious anaemia, terminal ileum disease). Pernicious anaemia = autoimmune destruction of gastric parietal cells → intrinsic factor deficiency → B12 malabsorption.
TOPIC 3: HAEMOLYTIC ANAEMIAS
Q9. [NEET PG 2019] The MOST COMMON cause of spherocytosis on peripheral smear is:
A) Hereditary spherocytosis
B) Autoimmune haemolytic anaemia (AIHA)
C) ABO incompatibility
D) Microangiopathic haemolytic anaemia
Answer: B - Autoimmune haemolytic anaemia (AIHA)
Explanation: This is a high-yield frequently tested fact. Although hereditary spherocytosis (HS) is the classic cause, AIHA is the most common cause of spherocytosis overall seen on peripheral smear. In AIHA, antibody coating causes RBC membrane loss → spherocytes.
Q10. [INI-CET 2021] G6PD deficiency - which of the following is TRUE?
A) Autosomal recessive inheritance
B) Heinz bodies seen on routine Leishman stain
C) Bite cells seen on peripheral smear during haemolytic crisis
D) Most common in Northern Europe
Answer: C - Bite cells seen during haemolytic crisis
Explanation:
- G6PD deficiency = X-linked recessive (most common in African/Mediterranean/Asian males)
- Heinz bodies (denatured Hb) seen on crystal violet / brilliant cresyl blue stain (NOT routine stain)
- Bite cells (degmacytes) = macrophages bite out Heinz bodies → characteristic smear finding
- Precipitants: primaquine, dapsone, fava beans, infections
Q11. [NEET PG 2022] Osmotic fragility test is INCREASED in:
A) Iron deficiency anaemia
B) Hereditary spherocytosis
C) Thalassaemia
D) Sickle cell anaemia
Answer: B - Hereditary spherocytosis
Explanation: Osmotic fragility is increased in conditions with spherocytes (HS, AIHA). It is decreased in thalassaemia, IDA, sickle cell disease (cells are resistant to osmotic lysis due to reduced SA:volume ratio).
Q12. [INI-CET 2022] Ham's test (acidified serum lysis test) is positive in:
A) G6PD deficiency
B) Paroxysmal nocturnal haemoglobinuria (PNH)
C) Hereditary spherocytosis
D) Sickle cell disease
Answer: B - PNH
Explanation: Ham's test = RBCs are lysed by acidified serum (complement activation at low pH) in PNH. PNH = somatic mutation in PIG-A gene → absent GPI anchors → absent CD55/CD59 → complement-mediated lysis. Flow cytometry (CD55/CD59 on RBCs) has now replaced Ham's test as the gold standard.
Q13. [NEET PG 2023] Which of the following is the GOLD STANDARD for diagnosis of PNH?
A) Ham's test
B) Sugar water test
C) Flow cytometry for CD55/CD59
D) Urine haemosiderin
Answer: C - Flow cytometry for CD55/CD59
Explanation: Flow cytometry demonstrating deficiency of GPI-linked proteins (CD55, CD59) on RBCs and granulocytes is the current gold standard for PNH diagnosis.
TOPIC 4: THALASSAEMIA & HAEMOGLOBINOPATHIES
Q14. [NEET PG 2020] In beta-thalassaemia minor, which of the following is the MOST characteristic finding?
A) HbF > 90%
B) HbA2 > 3.5%
C) HbS present
D) Absent HbA
Answer: B - HbA2 > 3.5%
Explanation: In beta-thalassaemia trait (minor): HbA2 is elevated (>3.5%, normally <3.2%) and HbF may be mildly elevated (2-5%). This is diagnosed by HPLC or Hb electrophoresis. Thalassaemia major shows absent/minimal HbA with HbF >90%.
Q15. [INI-CET 2021] Target cells are characteristically seen in all EXCEPT:
A) HbC disease
B) Thalassaemia
C) Liver disease
D) Hereditary spherocytosis
Answer: D - Hereditary spherocytosis
Explanation: Target cells (codocytes) are seen in: thalassaemia, HbC/HbS-C, liver disease, IDA, post-splenectomy. They are NOT seen in hereditary spherocytosis (which shows spherocytes). Mnemonic: HALT - HbC, Asplenia/liver disease, thalassaemia.
Q16. [NEET PG 2021] Sickle cell disease - vaso-occlusive crisis is precipitated by all EXCEPT:
A) Hypoxia
B) Dehydration
C) Cold
D) High altitude
Answer: None (all precipitate) - but commonly tested precipitant NOT listed in exams is HIGH ALTITUDE specifically
Explanation: Common precipitants of sickle cell crisis: infection, hypoxia, dehydration, cold, acidosis, high altitude, stress. Hydroxyurea is the disease-modifying agent (increases HbF production).
Q17. [INI-CET 2023] Which Hb variant has LEAST solubility and MAXIMUM tendency to sickle?
A) HbS
B) HbC
C) HbSS (homozygous)
D) HbSC
Answer: C - HbSS
Explanation: Polymerisation and sickling tendency: HbSS > HbSC > HbS-beta thalassaemia > HbAS (trait). HbF inhibits sickling (hence hydroxyurea benefit).
TOPIC 5: APLASTIC ANAEMIA
Q18. [NEET PG 2019] Aplastic anaemia - pancytopenia with hypocellular bone marrow. The MOST common cause is:
A) Radiation
B) Idiopathic / Immune-mediated
C) Chloramphenicol
D) Benzene exposure
Answer: B - Idiopathic / Immune-mediated (>70% cases)
Explanation: Aplastic anaemia is caused by T-cell mediated destruction of haematopoietic stem cells. Most common cause is idiopathic (immune). Drug causes: chloramphenicol (dose-independent idiosyncratic reaction), NSAIDs, sulfonamides. Treatment: allogeneic HSCT (young patients) or immunosuppression with ATG + cyclosporine (older patients).
Q19. [INI-CET 2022] Fanconi anaemia is associated with all EXCEPT:
A) Short stature
B) Hyperpigmentation
C) Absent radii with present thumbs
D) High risk of AML
Answer: C - Absent radii with present thumbs
Explanation: Fanconi anaemia shows radial ray defects - absent/hypoplastic thumbs with absent radii. Thrombocytopenia absent radii (TAR) syndrome shows absent radii WITH present thumbs. Other features of Fanconi: café-au-lait spots, renal anomalies, short stature, high risk of MDS/AML/squamous cell cancers.
TOPIC 6: LEUKAEMIAS
ACUTE LEUKAEMIAS
Q20. [NEET PG 2018] Auer rods on peripheral smear are pathognomonic of:
A) ALL
B) AML
C) CML
D) CLL
Answer: B - AML
Explanation: Auer rods = fused lysosomes (azurophilic rod-shaped inclusions) in blast cytoplasm. Pathognomonic of AML. Most commonly seen in AML M3 (APML). APML (M3) = t(15;17) → PML-RARA fusion → treated with ATRA (all-trans retinoic acid) + arsenic trioxide.
Q21. [INI-CET 2022] Faggot cells are seen in:
A) AML-M2
B) AML-M3 (APML)
C) ALL
D) CML blast crisis
Answer: B - AML-M3 (APML)
Explanation: Faggot cells = blasts containing multiple Auer rods bundled together like a "faggot of sticks." Pathognomonic of APML (AML-M3). These cells carry the risk of DIC due to release of granule contents.
Q22. [NEET PG 2020] Philadelphia chromosome t(9;22) is characteristically associated with:
A) AML-M3
B) ALL in adults
C) CML
D) Both CML and adult ALL
Answer: D - Both CML and adult ALL
Explanation: t(9;22) = BCR-ABL fusion:
- CML: present in >95% cases (p210 BCR-ABL)
- Adult ALL: present in ~30% (p190 BCR-ABL - worst prognosis)
- Childhood ALL: rare (~5%) Treatment with imatinib (tyrosine kinase inhibitor) targets BCR-ABL.
Q23. [INI-CET 2021] The MOST common type of ALL in children is:
A) T-cell ALL
B) B-cell ALL (pre-B, common ALL)
C) Burkitt ALL (L3)
D) Null cell ALL
Answer: B - B-cell precursor ALL (common ALL, CD10+)
Explanation: Most common childhood ALL is precursor B-cell ALL (CD10+, CD19+, TdT+). Best prognosis group: age 2-10 years, WBC <10,000, hyperdiploidy. Burkitt ALL (L3) = t(8;14), c-MYC rearrangement = worst prognosis.
Q24. [NEET PG 2022] Sudan Black B (SBB) stain is positive in:
A) ALL (lymphoblasts)
B) AML (myeloblasts)
C) CLL
D) Hairy cell leukaemia
Answer: B - AML (myeloblasts)
Explanation: Key cytochemical stains:
| Stain | Positive in |
|---|---|
| MPO (Myeloperoxidase) | AML |
| Sudan Black B | AML |
| PAS (periodic acid-Schiff) | ALL (block positivity) |
| NSE (non-specific esterase) | AML-M4/M5 (monocytic) |
| TRAP | Hairy cell leukaemia |
CHRONIC LEUKAEMIAS
Q25. [NEET PG 2019] Leukocyte alkaline phosphatase (LAP) score is LOW in:
A) Leukaemoid reaction
B) Polycythaemia vera
C) CML
D) Infection
Answer: C - CML
Explanation: LAP score differentiates CML from leukaemoid reaction:
- CML: LAP score low/absent (despite high WBC)
- Leukaemoid reaction: LAP score high
- PV: LAP score high
- Normal: 15-100
Q26. [INI-CET 2023] Smudge/basket cells on peripheral smear are characteristic of:
A) CML
B) CLL
C) AML
D) Multiple myeloma
Answer: B - CLL
Explanation: Smudge cells (Gumprecht shadows/basket cells) = fragile lymphocytes ruptured during smear preparation. Characteristic of CLL. CLL cells: small mature lymphocytes, CD5+, CD19+, CD23+, CD20+(dim). Most common leukaemia in adults in Western countries.
Q27. [NEET PG 2021] Richter transformation in CLL refers to transformation to:
A) AML
B) Diffuse large B-cell lymphoma (DLBCL)
C) Prolymphocytic leukaemia
D) Multiple myeloma
Answer: B - DLBCL
Explanation: Richter syndrome = transformation of CLL to aggressive DLBCL (most common, ~5-10% of CLL). Very poor prognosis. Rarely can transform to Hodgkin lymphoma.
TOPIC 7: LYMPHOMAS
Q28. [NEET PG 2018] Reed-Sternberg (RS) cells are characteristic of:
A) Non-Hodgkin lymphoma
B) Hodgkin lymphoma
C) Multiple myeloma
D) Burkitt lymphoma
Answer: B - Hodgkin lymphoma
Explanation: Classic RS cell = large binucleated cell with prominent "owl-eye" nucleoli. Background inflammatory cells (lymphocytes, eosinophils, plasma cells, neutrophils). RS cell origin: germinal centre B cell. CD15+, CD30+ (negative for CD20 in classic HL, except LP type).
Q29. [INI-CET 2022] Nodular sclerosis subtype of Hodgkin lymphoma is associated with:
A) Worst prognosis
B) Best prognosis
C) Most common subtype overall
D) Most common in elderly males
Answer: C - Most common subtype overall
Explanation: Subtypes of classical HL:
| Subtype | Features |
|---|---|
| Nodular sclerosis | Most common overall; young females; mediastinal mass |
| Mixed cellularity | 2nd most common; EBV associated |
| Lymphocyte rich | Best prognosis |
| Lymphocyte depleted | Worst prognosis; elderly; HIV |
| NLPHL (lymphocyte predominant) | Popcorn cells (L&H cells); CD20+; indolent |
Q30. [NEET PG 2022] Burkitt lymphoma is associated with:
A) t(9;22)
B) t(14;18)
C) t(8;14)
D) t(11;14)
Answer: C - t(8;14)
Explanation: Key lymphoma translocations:
| Translocation | Lymphoma |
|---|---|
| t(8;14) - c-MYC/IgH | Burkitt lymphoma |
| t(14;18) - BCL-2/IgH | Follicular lymphoma |
| t(11;14) - BCL-1/cyclin D1 | Mantle cell lymphoma |
| t(2;5) - ALK/NPM | ALCL (Anaplastic large cell) |
| t(11;18) | MALT lymphoma |
Q31. [INI-CET 2021] Starry sky appearance on histology is seen in:
A) Hodgkin lymphoma - mixed cellularity
B) Follicular lymphoma
C) Burkitt lymphoma
D) Multiple myeloma
Answer: C - Burkitt lymphoma
Explanation: Starry sky appearance = sheets of uniform small B-cells (dark sky) interspersed with pale macrophages engulfing apoptotic cells (stars). Burkitt has the highest proliferation rate of all tumours (Ki-67 ~100%).
TOPIC 8: MULTIPLE MYELOMA & PLASMA CELL DYSCRASIAS
Q32. [NEET PG 2020] CRAB criteria for multiple myeloma diagnosis includes all EXCEPT:
A) Hypercalcaemia
B) Renal failure
C) Anaemia
D) Bone marrow fibrosis
Answer: D - Bone marrow fibrosis
Explanation: CRAB criteria:
- C - HyperCalcaemia (Ca > 11 mg/dL)
- R - Renal failure (Cr > 2 mg/dL)
- A - Anaemia (Hb < 10 g/dL)
- B - Bone lesions (lytic lesions, osteoporosis, fractures)
Bone marrow fibrosis is a feature of myelofibrosis/MPN, not myeloma.
Q33. [INI-CET 2022] Rouleaux formation on peripheral smear is characteristically seen in:
A) Iron deficiency anaemia
B) Multiple myeloma / paraproteinaemia
C) Thalassaemia
D) Aplastic anaemia
Answer: B - Multiple myeloma / paraproteinaemia
Explanation: Rouleaux = RBCs stacked like coins due to high serum paraprotein (IgG/IgA) coating RBC surface and reducing zeta potential. High ESR is the classical finding. Bence-Jones protein (free light chains) in urine = characteristic.
Q34. [NEET PG 2021] Flame cells in bone marrow are seen in:
A) Acute myeloid leukaemia
B) Multiple myeloma (IgA type)
C) Hodgkin lymphoma
D) CLL
Answer: B - Multiple myeloma (IgA type)
Explanation: Flame cells = plasma cells with reddish cytoplasmic projections, seen specifically in IgA myeloma. Mott cells (Russell body cells with grape-like cytoplasmic Ig inclusions) are also seen in myeloma.
TOPIC 9: MYELOPROLIFERATIVE NEOPLASMS (MPN)
Q35. [NEET PG 2019] JAK2 V617F mutation is positive in what percentage of polycythaemia vera (PV) cases?
A) 20%
B) 50%
C) >95%
D) 100%
Answer: C - >95%
Explanation: JAK2 V617F mutation is present in:
- PV: >95%
- Essential thrombocythaemia (ET): ~50%
- Primary myelofibrosis (PMF): ~50% This is a constitutively activating mutation in the tyrosine kinase pathway driving myeloproliferation.
Q36. [INI-CET 2023] "Dry tap" on bone marrow aspiration is characteristic of:
A) Aplastic anaemia
B) Multiple myeloma
C) Primary myelofibrosis
D) CML
Answer: C - Primary myelofibrosis
Explanation: Dry tap (unable to aspirate marrow) occurs due to extensive marrow fibrosis. Biopsy shows collagen/reticulin fibrosis. Peripheral smear shows leukoerythroblastic picture (nucleated RBCs + immature WBCs) + tear-drop cells (dacrocytes) = classic PMF findings.
Q37. [NEET PG 2022] Spent phase of polycythaemia vera is characterized by:
A) Increasing haematocrit requiring more venesections
B) Development of myelofibrosis
C) Transformation to CLL
D) Disappearance of JAK2 mutation
Answer: B - Development of myelofibrosis
Explanation: PV natural history: proliferative phase → spent/post-PV myelofibrosis phase (cytopenias replace erythrocytosis) → AML transformation in ~5-10%.
TOPIC 10: BLEEDING DISORDERS & COAGULATION
Q38. [NEET PG 2019] A patient has prolonged PT but normal aPTT. Which factor deficiency is MOST likely?
A) Factor VIII
B) Factor IX
C) Factor VII
D) Factor XII
Answer: C - Factor VII
Explanation: Key coagulation pathway:
- PT (prothrombin time) = extrinsic + common pathway (Factors VII, X, V, II, fibrinogen)
- aPTT = intrinsic + common pathway (Factors XII, XI, IX, VIII, X, V, II, fibrinogen)
- Isolated prolonged PT = Factor VII deficiency (Factor VII is only in extrinsic pathway)
- Isolated prolonged aPTT = Factor VIII/IX/XI/XII deficiency (haemophilia A/B)
Q39. [INI-CET 2022] In Haemophilia A:
A) PT is prolonged, aPTT is normal
B) Both PT and aPTT are prolonged
C) aPTT is prolonged, PT is normal
D) Both are normal, only bleeding time prolonged
Answer: C - aPTT prolonged, PT normal
Explanation: Haemophilia A = Factor VIII deficiency (X-linked recessive). aPTT prolonged (intrinsic pathway defect). PT normal (extrinsic pathway intact). Bleeding time normal (platelet function intact). Factor VIII:C assay confirms diagnosis.
Q40. [NEET PG 2020] Von Willebrand disease (vWD) - which of the following is TRUE?
A) Bleeding time is normal
B) Factor VIII activity may be low
C) Platelet count is low
D) RIPA (ristocetin-induced platelet aggregation) is normal in Type 1 vWD
Answer: B - Factor VIII activity may be low
Explanation: vWD type 1/2/3: vWF is the carrier for Factor VIII in plasma. In vWD: vWF is reduced → Factor VIII is unprotected → Factor VIII levels also fall. Hence aPTT may be mildly prolonged. RIPA is reduced/absent in most vWD types (ristocetin requires vWF to agglutinate platelets). Bleeding time is prolonged (platelet plug formation impaired).
Q41. [INI-CET 2021] DIC (disseminated intravascular coagulation) - which is NOT a feature?
A) Prolonged PT and aPTT
B) Thrombocytopenia
C) Elevated fibrin degradation products (FDPs)
D) Elevated fibrinogen
Answer: D - Elevated fibrinogen (it is DECREASED in DIC)
Explanation: DIC = consumptive coagulopathy:
- ↓ Platelets (consumed)
- ↓ Fibrinogen (consumed)
- ↑ PT, ↑ aPTT (clotting factors consumed)
- ↑ FDPs/D-dimer (fibrinolysis)
- Microangiopathic haemolytic anaemia (schistocytes on smear)
Q42. [NEET PG 2023] Ristocetin cofactor assay is used to diagnose:
A) Haemophilia A
B) Von Willebrand disease
C) Thrombocytopenia
D) DIC
Answer: B - Von Willebrand disease
Explanation: Ristocetin causes platelet aggregation ONLY in the presence of functional vWF. In vWD, ristocetin-induced platelet aggregation (RIPA) is reduced/absent. Ristocetin cofactor assay measures vWF:RCo activity - the primary functional test for vWD.
TOPIC 11: PLATELET DISORDERS
Q43. [NEET PG 2021] Bernard-Soulier syndrome is due to deficiency of:
A) GPIIb/IIIa complex
B) GPIb-IX-V complex
C) Collagen receptor (GPVI)
D) P2Y12 receptor
Answer: B - GPIb-IX-V complex
Explanation: Bernard-Soulier syndrome (BSS) = autosomal recessive, deficiency of GPIb-IX-V (vWF receptor). Giant platelets + thrombocytopenia + prolonged bleeding time. Glanzmann thrombasthenia = deficiency of GPIIb/IIIa (fibrinogen receptor) → normal platelet count, giant platelets absent, failure of aggregation with all agents except ristocetin.
Q44. [INI-CET 2022] Glanzmann thrombasthenia - platelet aggregation is absent with all agents EXCEPT:
A) ADP
B) Collagen
C) Ristocetin
D) Adrenaline
Answer: C - Ristocetin
Explanation: In Glanzmann's, GPIIb/IIIa is absent → fibrinogen cannot bridge platelets → no aggregation with ADP, collagen, adrenaline, thrombin. Ristocetin-induced agglutination (NOT aggregation) uses the vWF-GPIb pathway which is intact → ristocetin response is NORMAL.
TOPIC 12: TRANSFUSION MEDICINE
Q45. [NEET PG 2019] A patient receives ABO-incompatible blood. The MOST feared immediate reaction is:
A) Febrile non-haemolytic reaction
B) Acute haemolytic transfusion reaction (AHTR)
C) Transfusion-associated lung injury (TRALI)
D) Anaphylaxis
Answer: B - AHTR
Explanation: ABO incompatibility → intravascular haemolysis (IgM anti-A/B + complement) → haemoglobinaemia, haemoglobinuria, renal failure, DIC, death. Earliest sign: fever, flank/back pain, burning sensation at infusion site. First action: STOP transfusion immediately.
Q46. [INI-CET 2023] Universal donor for red blood cells (packed RBCs) is:
A) AB+
B) O-
C) O+
D) AB-
Answer: B - O negative (O-)
Explanation:
- Universal donor (RBC): O negative (no A/B antigens, no Rh D)
- Universal recipient (RBC): AB positive
- Universal donor (plasma/FFP): AB (no anti-A or anti-B antibodies)
TOPIC 13: PERIPHERAL SMEAR - HIGH YIELD FINDINGS
| Smear Finding | Diagnosis |
|---|---|
| Hypersegmented neutrophils + macro-ovalocytes | Megaloblastic anaemia |
| Auer rods in blasts | AML |
| Smudge/basket cells | CLL |
| Tear-drop cells (dacrocytes) | Myelofibrosis |
| Target cells | Thalassaemia, liver disease, HbC, IDA |
| Schistocytes/helmet cells | TTP, HUS, DIC, MAHA |
| Spherocytes | AIHA, hereditary spherocytosis |
| Bite cells | G6PD deficiency |
| Rouleaux formation | Multiple myeloma |
| Pencil cells | Iron deficiency anaemia |
| Burr cells (echinocytes) | Uraemia, liver disease |
| Sickle cells | Sickle cell disease |
TOPIC 14: BONE MARROW FINDINGS
| Marrow Finding | Diagnosis |
|---|---|
| Hypocellular (fatty) marrow | Aplastic anaemia |
| "Dry tap" | Myelofibrosis |
| Auer rods in blasts | AML |
| Ringed sideroblasts | Sideroblastic anaemia |
| Flame cells | IgA myeloma |
| Pseudo-Gaucher cells | CML, thalassaemia |
| Sea-blue histiocytes | Niemann-Pick disease |
| Giant proerythroblasts | Parvovirus B19 aplastic crisis |
| 10% plasma cells | Myeloma (diagnostic criterion) |
QUICK REVISION: HIGH-YIELD MNEMONICS
Causes of PANCYTOPENIA (APLASTIC PANIC):
- Aplastic anaemia
- PNH
- Leukemia/lymphoma infiltration
- AIDS/viral
- SLE
- Toxins (benzene, radiation)
- Infections (TB, kala azar)
- Chemotherapy/drugs
Causes of HIGH ESR: Mnemonic - MICE TRAP
Myeloma, Infections, Collagen disorders, Endocarditis, TB, Rheumatoid, Anaemia, Pregnancy
These questions represent the most frequently recurring haematology topics across NEET PG (2017-2024) and INI-CET (2021-2024). For the most updated PYQs with verified answer keys, platforms like Marrow, PrepLadder, and DAMS maintain year-wise question banks with official answer keys.
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