Cell injury: haemosiderin: practice question

A Pathology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pathology · Cell injury: haemosiderin

Sample item

A 42-year-old woman with long-standing rheumatic mitral stenosis has breathlessness and rusty sputum. Bronchoalveolar lavage shows macrophages with golden-brown cytoplasm that stain blue with Prussian blue. What do these cells contain?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Haemosiderin from breakdown of red cells that leaked in chronic pulmonary congestion

In chronic pulmonary venous congestion, red cells leak into alveoli and are phagocytosed by macrophages, which convert haemoglobin iron into haemosiderin, a golden-brown iron-storage pigment that turns blue with Prussian blue. These are called heart failure cells. Their presence indicates previous alveolar haemorrhage from raised pulmonary capillary pressure.

Option by option

  • A. Lipid droplets from aspiration of oily material

    Lipid-laden macrophages stain with oil red O, not Prussian blue.

  • B. Haemosiderin from breakdown of red cells that leaked in chronic pulmonary congestion (correct)

    Correct. Prussian blue positive golden-brown macrophages contain haemosiderin.

  • C. Lipofuscin from ageing of alveolar macrophages

    Lipofuscin does not stain blue with Prussian blue and does not mark pulmonary congestion.

  • D. Carbon particles inhaled from air pollution

    Carbon is black and does not stain with Prussian blue.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is B, Haemosiderin from breakdown of red cells that leaked in chronic pulmonary congestion. In chronic pulmonary venous congestion, red cells leak into alveoli and are phagocytosed by macrophages, which convert haemoglobin iron into haemosiderin, a golden-brown iron-storage pigment that turns blue with Prussian blue.

Why is "Lipid droplets from aspiration of oily material" not the answer?

Lipid-laden macrophages stain with oil red O, not Prussian blue.

Why is "Lipofuscin from ageing of alveolar macrophages" not the answer?

Lipofuscin does not stain blue with Prussian blue and does not mark pulmonary congestion.

Why is "Carbon particles inhaled from air pollution" not the answer?

Carbon is black and does not stain with Prussian blue.

What concept does this question test?

It tests Cell injury: haemosiderin in Pathology. These are called heart failure cells. Their presence indicates previous alveolar haemorrhage from raised pulmonary capillary pressure.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cell injury: haemosiderin?

Learn each disease as a bundle: cause, key histology, markers, and the clinical hallmark. Then use the flashcards and the other Pathology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.