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Advanced Hematology-Pathology Diagnostic Challenges Quiz

Advanced Hematology-pathology Diagnostic Challenges Quiz

Explore the intricate world of blood disorders and cellular pathology with this focused assessment. Enhance your understanding and diagnostic skills in hematology-pathology, crucial for medical professionals and students aiming...

Questions: 27 | Attempts: 10 | Last updated: Aug 4, 2025

Sample Question 1
What is the next best step in the workup for a 21-year-old asymptomatic African-American woman with recurrent microscopic hematuria, normal renal ultrasonography, negative urine culture, and no casts present in the urine sediment?

Perform a kidney biopsy for further evaluation

Start empiric treatment with antibiotics for a possible urinary tract infection

Repeat urinalysis in one week

*Sickle cell screen (Induce sickling)The patient most likely has sickle cell trait(Aa), which causes recurrent microscopic hematuria.In sickle cell trait, the percentage of sickle hemoglobin is 40% to 45%, and the remainder of hemoglobin is hemoglobin A.*There are no sickle cells in the peripheral smear in sickle cell trait,therefore, a sickle cell screen is required to induce sickling of RBCs containing sickle hemoglobin. However, the O2 tension in the renal medulla is low enough to induce sickling of RBCs in the peritubular capillaries. This causes microinfarctions in the renal medulla leading to hematuria.*There is also the potential for renal papillary necrosis and subsequent loss of both concentration and dilution.

Sample Question 2
Why might a chronic alcoholic present with Pancytopenia?

Chronic alcohol inhibits bone marrow production of blood cells leading to Pancytopenia.

Chronic alcohol consumption directly damages blood cells causing Pancytopenia.

Chronic alcohol increases platelet production leading to Pancytopenia.

*Chronic alcohol>Cirrhosis>Portal hypertension>Congestive splenomegaly with too much blood getting stuck in spleen>Secondary Hypersplenism(Portal hypretension is MCC of hypersplenism)>Spleen sequesters RBCs,WBCs,Platelets>Too much of it>Pancytopenia.<Contrast this with Hyposplenia(For example after autosplenectomy in Sickle cell patient or After surgical removal of spleen) where you would see Basophillic Nuclear remnants(DNA remnant) in RBCs known as Howell-Jolly bodies.BOTH of these have been tested so know them

Sample Question 3
Female who complains of menorrhagia, sustained a minor cut and bleeding time was more then expected(more than 2-6 mins)...She received oral contraceptives. Her platelet count, PT, PTT are all normal...What is the likely diagnosis and treatment?

*She likely has Von willebrand disease-Most common inherited bleeding diathesis, it is autosomal dominant condition that involves lack of Factor 8, so PTT can be prolonged(In this patient it is not, remember that oral contraceptives increase release of vWF and factor 8, so it can be partially responsible), however the ONLY sign of this disease can be Prolonged bleeding time.

Thrombocytopenia - Treatment involves addressing the underlying cause and possible platelet transfusions.

Iron-deficiency anemia - Treatment involves iron supplements and identifying the source of bleeding.

Hemophilia A - Treatment involves replacing clotting factor VIII.