Advanced Hematology & Transfusion Medicine Cases | Exam Prep – 8 MCQs | Kenya MBChB

8 Year 3: Blood Transfusion exam questions on Advanced Hematology & Transfusion Medicine Cases | Exam Prep for medical students. Includes MCQs, answers, explana

This MCQ set contains 8 questions on Advanced Hematology & Transfusion Medicine Cases | Exam Prep in the Year 3: Blood Transfusion unit. Each question includes the correct answer and a detailed explanation for active recall and exam preparation.

Q1: A 62-year-old female presents with mucosal bleeding and a platelet count of 950,000/µL. Bone marrow biopsy shows clusters of large, mature megakaryocytes with 'staghorn' nuclei. Molecular testing is positive for CALR mutation. What is the primary risk factor for transformation to myelofibrosis?

  1. A. Extreme thrombocytosis ( 1.5 million)
  2. B. Presence of ASXL1 or EZH2 mutations
  3. C. Age 60 years
  4. D. Concurrent hemoglobin 16.5 g/dL

Correct answer: B – Presence of ASXL1 or EZH2 mutations

ASXL1 and EZH2 are epigenetic modifier mutations that drive disease progression in Essential Thrombocythemia toward myelofibrosis, independent of platelet count or age.

Q2: A 28-year-old female at 32 weeks gestation presents with schistocytic anemia, thrombocytopenia, and normal coagulation studies. ADAMTS13 is 45%. BP is 160/110 mmHg, urinalysis shows 3+ protein. What is the most likely diagnosis?

  1. A. Thrombotic Thrombocytopenic Purpura (TTP)
  2. B. Hemolytic Uremic Syndrome (HUS)
  3. C. HELLP Syndrome
  4. D. Disseminated Intravascular Coagulation (DIC)

Correct answer: C – HELLP Syndrome

HELLP (Hemolysis, Elevated Liver enzymes, Low Platelets) is confirmed by the pregnancy context, hypertension, and proteinuria. ADAMTS13 10% rules out TTP. Normal coagulation rules out DIC.

Q3: A 19-year-old male presents with massive lymphadenopathy. Biopsy shows 'starry sky' appearance. IHC positive for CD19, CD20, CD10, BCL-6, negative for BCL-2. Cytogenetics show t(8;14). Which metabolic complication is he at highest risk for during induction therapy?

  1. A. Hypercalcemia
  2. B. Hypouricemia
  3. C. Hypophosphatemia
  4. D. Tumor Lysis Syndrome with Hyperkalemia

Correct answer: D – Tumor Lysis Syndrome with Hyperkalemia

This is Burkitt Lymphoma (t(8;14), starry sky, BCL-2 negative). Its extremely high proliferation rate causes massive Tumor Lysis Syndrome upon treatment — releasing potassium, phosphate, and uric acid into the bloodstream.

Q4: A 70-year-old male with Waldenström Macroglobulinemia presents with sudden vision loss and epistaxis. Fundoscopy shows 'sausage-link' retinal veins. Serum viscosity is 4.5 centipoise. What is the immediate treatment?

  1. A. Rituximab monotherapy
  2. B. Emergent Plasmapheresis
  3. C. High-dose Dexamethasone
  4. D. Autologous Stem Cell Transplant

Correct answer: B – Emergent Plasmapheresis

Hyperviscosity syndrome is a medical emergency. Plasmapheresis rapidly removes the excess IgM paraprotein, immediately reducing serum viscosity and reversing symptoms. Rituximab is used later for disease control.

Q5: A 45-year-old male with fatigue, splenomegaly, WBC 120,000/µL, full myeloid spectrum on smear with basophilia, and t(9;22). Which molecular finding is most associated with the accelerated phase?

  1. A. Presence of BCR-ABL1 p190 isoform
  2. B. Isolated del(5q) mutation
  3. C. Additional trisomy 8 or second Ph chromosome
  4. D. Loss of JAK2 V617F

Correct answer: C – Additional trisomy 8 or second Ph chromosome

This is CML. Clonal evolution — acquiring additional chromosomal abnormalities like trisomy 8 or a second Philadelphia chromosome — signals progression to the accelerated phase, indicating loss of disease control.

Q6: A patient with WAIHA requires a transfusion. The antibody screen is pan-reactive. Which technique is most appropriate to identify underlying clinically significant alloantibodies?

  1. A. Cold autoadsorption
  2. B. Differential allogeneic adsorption
  3. C. Elution using acid reagents
  4. D. Pre-warming technique

Correct answer: B – Differential allogeneic adsorption

When autoantibodies mask alloantibodies, allogeneic adsorption using cells of different phenotypes (R1R1, R2R2, rr) removes the autoantibody while preserving detectable alloantibodies for identification.

Q7: Four hours after a platelet transfusion, a patient develops chills, 2°C fever rise, respiratory distress, BP 80/40 mmHg, bilateral infiltrates on CXR, and low PCWP. What is the most likely cause?

  1. A. Transfusion Associated Circulatory Overload (TACO)
  2. B. Febrile Non-Hemolytic Transfusion Reaction (FNHTR)
  3. C. Transfusion Related Acute Lung Injury (TRALI)
  4. D. Bacterial contamination

Correct answer: C – Transfusion Related Acute Lung Injury (TRALI)

TRALI presents with acute hypoxia, bilateral infiltrates, and low PCWP (ruling out cardiogenic cause). It occurs within 6 hours of transfusion and is caused by donor anti-HLA/HNA antibodies activating recipient neutrophils in the lungs.

Q8: A neonate with HDFN due to anti-D requires exchange transfusion. Mother is O negative, infant is A positive. What is the best blood product?

  1. A. A positive RBCs reconstituted with AB plasma
  2. B. O negative RBCs reconstituted with AB plasma
  3. C. O positive RBCs reconstituted with O plasma
  4. D. A negative RBCs reconstituted with A plasma

Correct answer: B – O negative RBCs reconstituted with AB plasma

O negative RBCs avoid both maternal anti-D (D-negative) and ABO incompatibility. AB plasma is used because it contains no anti-A or anti-B, making it safe for any infant ABO type.

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