HSBTE Important Questions Hematology IVth Semester DMLT for HSBTE Examination.

UNIT I

Haemostasis

• 1.1 Introduction to normal haemostasis.

• 1.2 Theories of Blood coagulation.

• 1.3 Platelets and their role in haemostasis including count.

• 1.4 Bleeding disorders and related diseases.

• 1.5 Principles, clinical importance, reference values, and methods of prothrombin time, prothrombin time index (PTI) International normalized ratio (INR), Activated Partial Thromboplastin time (APTT), Thrombin Time (TT), bleeding time (BT), Hess test, clotting time (CT), and clot retraction test (CRT).

• Section A

1. What is the normal fibrin degradation time?

a) 12 hours b) 24 hours b) 48 hours d) 72 hours

2. Anti-hemophilic factor is_________coagulation factor.

a) 1st b) 4th c) 8th d) XII

3. Calcium is_______coagulation factor

a) 3rd b) 4th c) 6th d) None of these

4. When blood vessels is damaged, bleeding stops by a process called:

a) Coagulation b) Hemostasis c) Bleeding time d) Clotting time

5. Antihemophilic factor is____

a) VII b) VIII c) IX d) XV

6. What is the normal Bleeding time?

a) 30-45 Minutes b) 1 - 7 minutes c) 10 -13 seconds d) 0 -5 seconds

7. Which method is used to determine the Clotting Time?

a) Lee-White Method b) Duke's Method c) Both A& B d) None of these

8. XIII is activated by________ into XIIIa.

a) Naturally activation b) Thrombin c) Tissue thromboplastin d) None of these

9. What is the normal clot retraction time?

a) 1 hour b) 24 hours) 48-hour d) 72 hour

10. What is the normal fibrin degradation time?

a) 12 hours b) 24 hours c) 48 hours d) 72 hours

11. The process in which bleeding stops from injured blood vessels is known as______

a) Haemostasis b) Haematology c) Leukocytosis d) None of these

12. Hemophilia occurs due to the deficiency of factor VIII.

a) Haemophilia-B b) Haemophilia-A c) Haemophilia-C d) None of these

13. Which method is used to determine the Bleeding Time?

a) Lee-White Method b) Duke’s Method c) Both A & B d) None of these

14. What is the normal clotting time?

a) 30-45 Minutes b) 5-10 Minutes c) 10-13 second d) 0-5 seconds

15. XIII is activated by______into XIIIa.

a) Naturally activation b) Thrombin c) Tissue thromboplastin d) None of these

SECTION B

• 1. Define Hemostasis.

• 2. What is the normal Clot Retraction Time?

• 3. Define Haemophilia A

• 4. Define thrombin time.

• 5. Define platelet and write its normal value.

• 6. Expand CT & BT.

• 7. Normal THROMBIN TIME is__________

• 8. Normal Range of Bleeding Time.

• 9. Define clotting Time.

• 10. Define Thrombocytopenia.

• 11. Define blood co-agulation.

• 12. Write the causes of Haemophilia-A.

• 13. Define Hess Test.

• 14. Expand PTI & APTT.

• 15. Explain Prothrombin Time Index.

• 16. Write the Normal range of Clotting times.

• 17. Normal APTT is______

• 18. Name two methods used for bleeding Time.

• 19. Expand CRT & INR.

SECTION C

1. Write the procedure of bleeding time by Ivy method.

2. Clinical importance of prothrombin time index.

3. Describe the Hess test in brief (Imp).

4. Explain the mechanism of hemostasis in brief.

5. Explain hemophilia A & hemophilia B in brief.

6. Principle and procedure for Prothrombin Time (Imp).

7. Write the names of Coagulation factors. OR Expand the name of Coagulation factors (Imp).

8. Clinical importance of Bleeding time.

9. Principle and procedure for Thrombin Time.

10. Explore coagulation cascade (Imp).

11. Explain the role of platelets in Haemostasis.

12. Explain hereditary Disorders in brief.

13. Describe the procedure of Duke's method.

14. Describe the procedure of Thrombin Time.

15. Role of platelets in Hemostasis.

16. Write some causes of bleeding disorder

17. Lee-white technique for Clotting time determination

18. Roll of Coagulation Factors in Hemostasis.

SECTION D

1. Describe the principle procedure, clinical importance, and reference value bleeding time by Duke's method. OR Explain the Principle, Procedure, and clinical significance of Bleeding Time by Duke's method.

2. Explain the Mechanism of blood coagulation in detail. (Imp).

3. Hemostasis and its various stages. (Imp)

4. Explain the Mechanism of Homeostasis in detail

5. Explain the Principle, Procedure, and clinical significance of Clotting Time by the Lee-White method.

6. Explain the principle clinical importance and method of prothrombin time.

Unit II

1. What is Bone marrow?

a) Soft, spongy tissue b) Cell c) Sensory organ in brain d) None of these.

Ans: a) Soft, spongy tissue

2. Which staining is used to examine the presence of iron content in bone marrow smear?

a) Perl's Staining b) AFB Staining c) Both A and B d) None of these.

Ans: a) Perl's Staining.

3. Name two types of Bone marrow.

Ans: Red Bone marrow and Yellow Bone marrow.

4. . What is marrow?

a) Hardest cartilage connective tissue

b) Hollow anterior of the brain

c) Marrow is a sensory organ in the brain

d) None of these

Ans: d) None of these

5. The total volume in adult bone marrow is_______/ml.

a) 4000 b) 3000 c) 2000 d) 1000.

Ans: Confusing question

Note: The total volume of bone marrow in adults varies. On average it's estimated to be around 4 to 5 milliliters per kilogram of body weight. So, for a typical adult weighing around 70 kilograms (154 pounds), the total volume of bone marrow would be approximately 280 to 350 milliliters. However, individual variations can exist.

6. Define Bone marrow. OR Define Marrow.

Ans: Bone marrow is the soft and spongy tissue found inside long bones bones consist of components of the hematopoietic system to produce blood cells.

7. Define Red Bone marrow.

Ans: Red bone marrow (myeloid tissue) is a specialized type of bone marrow found in the spongy cavities of certain flat bones like the pelvis, sternum, skull, ribs, and the epiphyses of long bones to produce blood cells (hematopoiesis). Red bone marrow appears red due to the presence of a large number of red blood cells.

8. Define Yellow Bone marrow.

Ans: Yellow Bone Marrow is specialized bone marrow mainly found in the medullary cavities of long bones and consists of mostly of adipocytes (fat cells), with fewer hematopoietic cells. They are sites for fat storage and serve as a reserve of energy with reduced hematopoietic activity compared to red bone marrow.

9. Write any four functions of Bone marrow.

Bone marrow is found within the cavities of bones. It performs the following functions:

i. Hematopoiesis: The function of bone marrow is to produce blood cells through a process called hematopoiesis. This includes the production of red blood cells (erythropoiesis), white blood cells (leukopoiesis), and platelets (thrombopoiesis)..

ii. Immune Function: Bone marrow plays a vital role in the body's immune response by producing various types of white blood cells, including lymphocytes, monocytes, and granulocytes. These cells are crucial for defending the body against infections and pathogens.

iii. Storage of Stem Cells: Bone marrow contains hematopoietic stem cells (HSCs), which can differentiate into various types of blood cells. These stem cells serve as a reservoir for replenishing the blood cell populations throughout life and play a crucial role in tissue repair and regeneration.

iv. Mineral Homeostasis: Bone marrow is involved in maintaining mineral homeostasis, particularly calcium and phosphate levels in the bloodstream. It helps regulate bone metabolism by storing and releasing minerals as needed, which is essential for bone health and overall metabolic balance.

10. Name of two needles used for bone marrow aspiration.

i. Trocars: Trocars are large-bore needles with sharp, pointed tip used to penetrate the outer layer of the bone (cortex) during bone marrow aspiration.

ii. Jamshidi Needle: The Jamshidi needle is a specialized type of biopsy needle commonly used for bone marrow aspiration and biopsy procedures. It has a hollow core for aspirating bone marrow samples.

11. How to prepare bone marrow smears?

Ans: Preparing bone marrow smears involves several steps to ensure accurate and clear samples for examination under a microscope. The following steps are followed to prepare bone marrow smears:

• Necessary Supplies: Clean glass slides, Coverslips, Syringe with anticoagulant (e.g., heparin or EDTA), Needles for aspiration, Fixative solution (e.g., methanol or ethanol), Staining solutions (e.g., Wright-Giemsa stain), Distilled water Gloves and other personal protective equipment.

• Collecting the Bone Marrow Sample:

  • · Choose an appropriate site for aspiration, such as the posterior iliac crest or sternum.

  • · Clean the aspiration site with an antiseptic solution.

  • · Use a syringe with an appropriate needle to aspirate bone marrow into the syringe. Mix the aspirate gently to prevent clotting.

• · Preparing Smears:

  • · Place a clean glass slide on a flat, stable surface.

  • · Using another clean glass slide, spread a small drop of the bone marrow aspirate across the surface of the first slide.

  • · Quickly and smoothly spread the aspirate by tilting the second slide at a 30-45 degree angle while gently pushing it across the first slide. This spreads the sample thinly and evenly, creating a smear.

• Air Drying:

  • · Allow the smears to air dry completely at room temperature. This typically takes several minutes to ensure the sample adheres well to the slide.

• Fixation:

  • · Once dry, fix the smears to preserve cellular morphology. This is usually done by immersing the slides in a fixative solution (such as methanol or ethanol) for several minutes. Alternatively, smears can be air-dried and fixed using a commercial fixative spray.

12. Describe compositions, function, and Examination of bone marrow

OR

Explain the composition, function, preparation, staining & examination of bone marrow.

Ans: Bone marrow is a soft, spongy tissue found in the cavities of long bones such as the femur and pelvis. It plays a vital role in the production of blood cells, immune function, and storage of fat.

• Composition: The composition of bone marrow can be divided into two main types: red bone marrow and yellow bone marrow.

  • Red Marrow:

    • · Red marrow is responsible for hematopoiesis, the process of producing blood cells. It is highly vascular and contains a rich supply of blood vessels and capillaries.

    • · Red marrow consists of hematopoietic stem cells (HSCs), which are precursor cells capable of differentiating into various types of blood cells such as red blood cells (erythrocytes), white blood cells (leukocytes), and platelets (thrombocytes).

    • · The stroma of red marrow includes reticular fibers, which provide structural support, and adipocytes (fat cells).

    • Red marrow is found in the flat bones (such as the sternum, ribs, skull, and pelvis) and long bones.

• Yellow Marrow:

  • · Yellow marrow is composed of adipocytes (fat cells). It has a lower vascularity compared to red marrow.

  • · It serves as a storage site for fat and functions as a reserve of energy.

  • · Yellow marrow can be found in the central cavities of long bones, replacing red marrow as a person ages.

  • · In times of severe blood loss or increased demand for blood cell production, yellow marrow can revert to red marrow to support hematopoiesis. This process is known as "red marrow conversion."

• Normal ranges for differential counts bone marrow/smear

  • i. Reticulocytes: 6.1 to 2%

  • ii. Hemocytoblasts: 0.1 to 1%

  • iii. Myeloblasts: 0.1 to 3.5%

  • iv. Promyeloblasts: 0.5 to 5%

  • v. MYELOCYTES:

    • a. Neutrophils: 5 to 20%

    • b. Eosinophils: 0.1 to 3%

    • c. Basophils: 0 to 0.5%

• vi. METAMYLOCYTES

  • a. Stab forms: 10 to 30%.

• vii. POLYMORPHONUCLEARS

  • a. Neutrophils: 7 to 25%

  • b. Eosinophils: 0.2 to 3%

  • c. Basophils: 0 to 0.5%

• viii. Lymphocytes: 5 to 10%

• ix. Monocytes: 0 to 0.2%

• x. Megakaryocytes: 0.1 to 0.5%

• xi. Plasma cells: 0.1 to 3.5%

• xii. Proerythroblasts: 0.5 to 5%

• xiii. Normblasts:

• xiv. Polychromatic: 2 to 20%

• xv. Pyknotic (Orthocromatic): 2 to 10%

Function of Bone Marrow: The bone marrow is a dynamic tissue. It continuously produces blood cells. Its composition and function are tightly regulated to maintain homeostasis in the circulatory and immune systems.

• i. Hematopoiesis: The primary function of bone marrow is hematopoiesis. The formation and development of blood cells are called hematopoiesis. Hematopoietic stem cells (HSCs) in the bone marrow have the ability to differentiate into various blood cell types, such as red blood cells, white blood cells, and platelets.

• ii. Erythropoiesis: Red bone marrow is responsible for the production of red blood cells (erythrocytes). The formation of red blood cells is called Erythropoiesis.

• iii. Leukopoiesis: Bone marrow produces different types of white blood cells, such as neutrophils, lymphocytes, monocytes, eosinophils, and basophils. The formation of white blood cells is called Leukopoiesis.

• iv. Thrombopoiesis: The process of forming platelets in bone marrow is called thrombopoiesis.

• v. Storage of Nutrients: Bone marrow stores various nutrients, including iron in association with hemoglobin production and calcium needed for bone health.

• vi. Fat Storage: Yellow bone marrow stores fat. It converts fat to red bone marrow during times of increased hematopoietic demand.

• vii. Cellular Support: Stromal cells in the bone marrow provide a supportive environment for hematopoiesis. These cells produce extracellular matrix and growth factors that regulate the development and function of blood cells.

Preparation of Bone Marrow Smears for Myelogram

• 1. Patient Preparation: Obtain informed consent from the patient. Explain the procedure to the patient, addressing any concerns. Ensure that the patient's coagulation status is within normal limits.

• 2. Procedure: The bone marrow sample is typically obtained through bone marrow aspiration or biopsy. Smears are prepared on glass slides by spreading a small amount of bone marrow aspirate across the sterile and clean slide surface.

• 3. Staining of Bone Marrow Smears: Wright-Giemsa Stain is the most commonly used stain for bone marrow smears. It provides a multicolor stain that allows for the visualization of different cell types.

  • · The smear is flooded with Wright-Giemsa stain for a specific period.

  • · After staining, the slide is washed with buffer or water.

  • · The slide is then air-dried before microscopic examination.

Examination of Bone Marrow Smears

• 1. Microscopic Examination: The stained bone marrow smear is examined under a microscope. Different types of cells are identified based on their morphological characteristics, such as size, shape, and staining properties. Important cell types include erythroblasts, myeloblasts, lymphocytes, monocytes, and megakaryocytes.

• 2. Myeloid to Erythroid (M.E.) Ratio: The M.E ratio is based on counting 200 to 500 cells. The Myeloid to Erythroid ratio (M.E. Ratio) is calculated to assess the relative proportions of myeloid cells (such as myeloblasts and granulocytes) to erythroid cells (erythroblasts). An increased M.E. Ratio suggests a myeloproliferative disorder, while a decreased ratio indicates erythroid hyperplasia or other conditions affecting erythropoiesis.

Interpretation of Results

• i. Cellular Composition: The myelogram provides information about the distribution and maturation of different hematopoietic cells in the bone marrow.

• ii. Cell Abnormalities: Abnormalities in cell morphology, such as the presence of immature cells (blast cells), abnormal cell shapes, or cytogenetic abnormalities are indications of various hematological disorders.

• iii. M.E. Ratio: An abnormal M.E. Ratio provides valuable information about the underlying pathology and guides further diagnostic workup.

• iv. Normal range: 2.5-15:1

13. Explain the procedure of Iron staining.

Iron staining (Perls' reaction or Perl's Prussian blue reaction) is a histological staining technique used to detect the presence of iron deposits in tissue samples. This staining method is particularly useful in pathological examinations, where the accumulation of iron indicates various conditions such as hemochromatosis, hemosiderosis, and certain types of anemia.

Principle: The Perls' reaction is based on the ability of ferric iron (Fe^3+) to form a complex with potassium ferrocyanide (also known as potassium hexacyanoferrate II) under acidic conditions. This complex is known as Prussian blue. In tissues containing iron deposits, the Prussian blue complex forms specifically at sites where ferric iron is present, allowing for visualization of iron accumulation.

Procedure:

i. Tissue sections are deparaffinized and hydrated using standard histological techniques.

ii. The sections are then treated with a reagent containing equal parts of potassium ferrocyanide and hydrochloric acid. This acidic environment converts ferric iron to ferrous iron (Fe^2+).

iii. Following this, the sections are rinsed with distilled water to remove excess reagents.

iv. A solution of ferric chloride is applied to the tissue sections. In the presence of ferrous iron, ferric chloride reacts with the ferrocyanide ions to form the Prussian blue complex.

v. After a brief incubation period, the tissue sections are rinsed with distilled water to remove any unbound reagents.

vi. Finally, the sections are counterstained with a nuclear stain, such as nuclear fast red or hematoxylin, to visualize cellular structures.

Interpretation:

Under a microscope, tissue sections stained with the Perls' reaction will show blue staining in areas where iron deposits are present. The intensity of the blue staining correlates with the amount of iron accumulation.

The Prussian blue staining is typically localized within cells or extracellular spaces where iron has accumulated, such as macrophages containing hemosiderin, a complex of ferric iron and protein.

Control: To ensure the accuracy of the staining, positive and negative controls should be included in the staining procedure. Positive controls may include tissue sections known to contain iron deposits, while negative controls involve omitting the reagents to check for nonspecific staining.

14. Which one is soft blood forming Tissue?

a) Blood b) Bone Marrow c) Both A & B d) None of these

Ans: b) Bone Marrow

15. Which needles are used for Bone Marrow aspiration?

a) Salah’s needle b) Klima’s needle c) Islam needle d) All of these

Ans: d) All of these

Note: Salah's needle, Klima's needle, and Islam needle are all types of needles used for bone marrow aspiration procedures. These needles are designed specifically for accessing the bone marrow cavity and aspirating bone marrow samples for diagnostic purposes. Each needle may have slightly different features or designs, but they serve the same function in bone marrow aspiration.

15. Significance of Bone Marrow Examination.

OR

Clinical Significance of Bone Marrow Examination.

OR

Write the clinical significance of Bone marrow.

Ans: Bone marrow examination is a diagnostic procedure. This examination provides valuable information about the health and functioning of the bone marrow, blood cells, and certain systemic conditions.

The following are the significance of bone marrow examination.

• i. Diagnosis of Blood Disorders: Bone marrow examination diagnoses various blood disorders, such as leukemia, lymphoma, etc. Abnormalities in the number, size, or structure of blood cells can be detected through this examination.

• ii. Staging and Monitoring of Cancer: The bone marrow examination is essential for staging the disease and monitoring the effectiveness of treatment of hematologic cancers like leukemia and lymphoma. It helps determine the extent of cancer involvement in the bone marrow.

• iii. Blood Cell Production: Bone marrow is responsible for the production of blood cells. By examining the bone marrow, doctors can assess the status of blood cell production and identify any abnormalities.

• iv. Evaluation of Bone Marrow Disorders: Certain non-cancerous conditions affecting the bone marrow, such as aplastic anemia, myelofibrosis, and hemophagocytic syndromes are diagnosed and characterized through bone marrow examination.

• v. Evaluation of Anaemia: Anemia is a condition characterized by a reduced number of red blood cells or a hemoglobin deficiency. Bone marrow examination helps in determining the cause of anemia. This detects anemia due to decreased production of RBC, increased destruction of RBC, or other underlying factors.

• vi. Assessment of Infection: Bone marrow examination is used to investigate certain infections, such as tuberculosis or fungal infections. It provides information on the involvement of the bone marrow in the immune response to infections.

• vii. Identification of Metastatic Diseases: The cancer cells from solid tumors can metastasize to the bone marrow. Bone marrow examination helps in the identification of these metastatic cells. This provides information about the spread of cancer.

• viii. Transplantation Planning: A thorough examination of the donor's and recipient's bone marrow is conducted to ensure compatibility. It also assesses the health of the bone marrow before hematopoietic stem cell transplantation (bone marrow transplant).

16. Pearl's Prussian Blue for Iron Staining.

OR

Explain Perl's staining method.

Ans: Iron staining (Perls’ reaction).

Perls' Prussian blue reaction is a histochemical staining method. It is used to detect and visualize iron deposits in tissues. This staining technique is useful in pathology to identify the presence of iron conditions such as hemochromatosis, hemosiderosis, and certain anemias.

Perls' Reaction for Iron Staining

• Reagents

  • · 2% Hydrochloric Acid (HCl),

  • · 2% Potassium Ferrocyanide Solution (Perls' Reagent),

  • · Nuclear Fast Red Counterstain.

• Procedure

  • · Deparaffinization and Hydration: Deparaffinize and hydrate the tissue sections through a series of xylene and graded alcohol washes.

  • · Pearl’s Reaction: Incubate tissue sections in a 2% hydrochloric acid (HCl) solution for 20 minutes. This step enhances the reaction by removing loosely bound iron from the tissues. Rinse the sections in distilled water.

  • · Incubation in Pearl’s Reagent: Incubate the tissue sections in a freshly prepared 2% potassium ferrocyanide solution (Perls' reagent) for 30 minutes to 1 hour. This reagent reacts with ferric iron to form a blue precipitate (Prussian blue).

  • Rinse: Rinse the sections in distilled water to remove excess Perls' reagent.

  • · Counterstaining: Counterstain the sections with Nuclear Fast Red for a short period (e.g., 5 minutes). This visualizes the cellular structures.

  • · Dehydration and Monitoring: Dehydrate the sections through a series of graded alcohols. Clear the sections in xylene. Mount the sections with a suitable mounting medium.

• Result: Iron deposits will appear blue (Prussian blue) under the microscope. It indicates the presence of iron in the tissue. Cellular structures are counterstained with Nuclear Fast Red, This develops contrast.

• Discussion: Perls' reaction specifically stains ferric iron, forming the blue Prussian blue complex. It does not stain ferrous iron. The reaction can detect even small amounts of iron deposits. The intensity of staining and the distribution of iron deposits can provide information about the extent and nature of iron overload or deposition in tissues.

• This staining method is a valuable tool in the diagnosis and characterization of various iron-related disorders and plays a role in understanding the pathophysiology of diseases involving iron metabolism.

13. What is marrow?

• a) Hardest cartilage connective tissue b) Exterior of the bones c) Marrow is a sensory organ in the brain d) None of these

• Ans: d) None of these

14. What is the normal Erythroid and Fat cell ratio?

• Ans: The normal erythroid (red blood cell) to fat cell ratio in bone marrow can vary depending on factors such as age, gender, and underlying health conditions. In a healthy adult bone marrow, the ratio of erythroid cells to fat cells is typically around 4:1 or higher.

• However, it's essential to note that this ratio can change under different circumstances. For instance, in conditions like myelofibrosis or certain types of leukemia, the ratio may be altered due to increased fibrosis (scar tissue formation) or infiltration of abnormal cells, respectively. Additionally, as individuals age, there tends to be an increase in fat content in the bone marrow, which can affect the ratio of erythroid to fat cells.

15. What is a normal mylogram?

A myelogram involves the preparation, staining, and examination of bone marrow smears to assess the cellular composition of the bone marrow. The myelogram is a valuable diagnostic tool used in the evaluation of various blood disorders, including leukemia, anemias, and other hematological conditions. It provides more useful qualitative information than time consuming differential counts.

1. Explain Bone marrow aspiration in detail.

OR

Describe the Bone marrow Aspiration and Biopsy.

OR

Describe the procedure of bone marrow aspiration.

OR

Briefly describe the Bone marrow Aspiration and Biopsy.

Ans: Aspiration of bone marrow by various methods

Aspiration of bone marrow is the withdrawal of a sample of bone marrow for diagnostic or therapeutic purposes. The procedure is commonly performed from the posterior iliac crest (hip bone), the sternum (breastbone), or other bones. Bone marrow aspiration is often used to evaluate blood disorders, leukemia, infections, and other conditions. The following methods are used for aspiration of bone marrow.

1. Iliac Crest Aspiration: This method is used for adult patients.

• · Patient Positioning: The patient is usually placed in a prone (face-down) or lateral decubitus (side-lying) position. The main advantage is that patients cannot see what is happening. Several attempts at puncture and aspiration can be made.

• · Site Selection: The posterior iliac crest is the most common site for bone marrow aspiration. It is located on the back of the hip bone. A large volume of bone marrow can be aspirated from this area.

• · Local Anesthesia: The skin over the chosen site is cleaned and a local anesthetic is applied to reduce pain.

• · Needle Insertion: A thin, hollow needle is inserted through the skin and into the bone. Allow needle penetration into the cortical bone to reach the marrow cavity.

• · Aspiration: A syringe is attached to the needle. Bone marrow is aspirated into the syringe by applying negative pressure.

2. Sternum (Breastbone) Aspiration: This method is used for adult patients. It is preferred over the Iliac Crest Aspiration method. It is the ideal method due to the following reasons

• i. The bone is near the surface.

• ii. The cortical bone is thin and

• iii. The bone marrow cavity in the sternum contains numerous cells of little fat.

Procedure

• · Patient Positioning: The patient is usually placed in a supine (lying on the back) position.

• · Site Selection: The sternum is used as a site for bone marrow aspiration.

• · Local Anesthesia: Local anesthetic is applied on the skin over the sternum.

• · Needle Insertion: There are many types of needle but Salah’s needle and Klima’s needle are mainly used.

Methods of sterna puncture:

• · Allow the patient to lie on a firm bed. The clean first and second pieces of sternum.

• · Sanitize it using spirit iodine and again by spirit.

• · Insert the needle in the midline of the sternum at the second interspace.

• · When the needle is at the periosteum, anaesthetize the area and push the needle further 5 mm.

• · Push the needle with a boring motion into the bone cavity. Suck up not more than 0.3 mL of bone marrow material.

• · Aspiration: Aspiration is performed by attaching a syringe to the needle and creating negative pressure to withdraw the bone marrow sample.

3. Tibial Aspiration: This method is used for infant patients.

• · Patient Positioning: The patient is usually placed in a prone or lateral decubitus position.

• · Site Selection: The tibia (shinbone) can be used as an alternative site for bone marrow aspiration, particularly in pediatric patients.

• · Local Anesthesia: Local anesthetic is applied on the skin over the tibia.

• · Aspiration: The bone marrow sample is aspirated using a syringe attached to the needle

Post-Procedure Considerations

• · After the procedure, pressure is applied to the site to minimize bleeding.

• · The bone marrow aspirate is examined under a microscope to assess cell morphology, count, and other characteristics.

• · Complications are generally rare but may include pain, bleeding, or infection at the aspiration site

Bone Marrow Biopsy:

· Procedure: In a bone marrow biopsy, a larger needle is used to remove a small core of bone and bone marrow tissue from the bone marrow space. This tissue sample is then examined under a microscope.

· Purpose: Bone marrow biopsy provides a more detailed assessment of the bone marrow architecture, including the cellular composition, distribution of cells, and presence of any abnormalities such as fibrosis or infiltration by cancer cells. It helps in the diagnosis of blood disorders, evaluating bone marrow diseases, and assessing the response to treatment.

Dr Pramila Singh

UNIT III

Leukemia

3.1 Definition of leukemias.

3.2 (FAB) Classifications.

3.3 Laboratory diagnosis of various leukemias

SECTION A

1. MPO staining is done for the demonstration of the:

a) Leukocyte peroxidase activity

b) Red cell peroxidase activity

c) Both a and b

d) Platelet peroxidase activity

2. In which year FAB classification of ALL was introduced?

a) 1946 b) 1988 c) 1976 d) 1968

SECTION B

1. Define prolymphocytic leukemia.

2. Define chronic leukemia.

3. Define hairy cell leukemia

4. Explain the lab diagnosis of AML

5. Define MPO.

6. What is CML?

7. Expand ALL & CLL?

8. What is Acute Leukaemia?

9. Explain the Lab diagnosis of CML

10. Expand AML & CML.

11. Define Leukemia.

12. Write the various symptoms of Leukemias. (Imp)

13. Define Acute Myeloblastic leukemia.

14. CML stands for ________.

15. Define Subleukemic Leukaemia.

16. Explain AML.

SECTION C

1. Write a short note on "leukemias".

2. Describe laboratory diagnosis of CLL

3. Write a short note on FAB Classification .(Imp)

4. Describe Laboratory diagnosis of CLL

SECTION D

1. D e f i n e l e u k e m i a & e x p l a i n FA B classification in brief.

2. Classification of Leukemia.(Imp)

3. Expand FAB classification

4. Explain Leukemia's in detail.

5. Differentiate between Myeloid & Lymphoid Leukemic.

6. Describe Lab. diagnosis of various leukaemias.

7. Write the classification of various types of Leukaemias.

UNIT IV

LE Cell Phenomenon

4.1 Phenomenon of LE cell, its differentiation from tart cell.

4.2 Demonstration of LE cell by various methods.

4.3 Clinical significance.

SECTIONA

1. When was LE-cell first described in the bone marrow?

a) 1948 b) 1848 c) 1968 d) 1868

SECTION B

1. Define LE-cell

2. What is Tart Cell?

.

SECTION C

1. D e s c r i b e o n e m e t h o d u s e d f o r demonstration of LE cell(Imp).

2. Clinical significance of LE cell.

3. Differentiate between tart cell & LE cell.

4. Draw the structure of LE cell.

SECTION D

1. Diagnosis of LE Cell with principle and procedure.

2. Diagnosis of LE Cell haematological with principle and procedure.

3. Explain demonstration of LE Cell with principle, procedure & Clinical significance.

UNIT V

Biological Body Fluids

5.1 Semen Analysis in detail.

5.2 Cell counts of various biological fluids.

SECTION A.

1. What is the normal %age of spermatozoa in Seminal fluids?

a) 4-10% b) 50-60% c) 20-45% d) None of these

2. Pleural fluid is generally obtained from:

a) Lumber puncture b) Brain c) GIT d) Lungs

3. Which body fluid obtained from joints?

a) CSF b) Synovial fluids c) Semen d) None of these

4. What is the normal Liquefaction time of semen?

a) 30-45 Minutes b) 15-20 minutes c) 10-13 second d) 0-5 seconds

5. CSF is generally obtained from:

a) Lumber puncture b) Brain c) GIT d) Lungs

SECTION B

1. What is Ejaculation?

2. pH and normal volume of semen.

3. What is Ascites?

4. Expand CSF & AFB.

5. What is Liquefaction time?

6. Synovial fluid is obtained from________?

7. What is CSF?

8. Color and pH of semen.

9. Write down the normal value of sperm count.

10. Define Synovial fluid

11. pH of Urine is ______.

SECTION C

1. Explain the Microscopic examination of synovial fluid.

2. Normal findings of Pleural Fluid.

3. Write a short note on Semen analysis. (Imp)

4. Draw the abnormal morphology of Sperm.

5. Write down the composition of CSF.

6. Draw the Morphology of spermatozoa(Imp)

7. Explain the Microscopic Examination of CSF in brief.

8. Write the interpretations of semen analysis.

9. Write the collection procedure of CSF.

10. Write the composition of synovial fluid.

11. Enlist various biological fluids.

12. Describe the clinical significance of semen.

13. Explain the procedure of semen analysis.

14. Normal findings of Pleural Fluid.

15. Special semen examination

SECTION D

1. Explain the collection, Examination, and clinical significance of Semen analysis.

2. Explain the cell count of CSF.

3. Explain Cell count in synovial fluid in brief. OR Cell counts technique for synovial fluid and their possible results

4. Cell count technique for Pleural effusion and their possible results

5. Write a detailed note on semen Analysis.

Dr Pramila Singh.