Haematology: aplastic anaemia: 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 · Haematology: aplastic anaemia

Sample item

A 22-year-old man has fatigue, bruising and infections. Counts show pancytopenia with low reticulocytes, and there is no splenomegaly or lymphadenopathy. Marrow biopsy shows a hypocellular marrow with fat replacement and no abnormal cells. What is the most likely mechanism in most acquired cases?

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

The answer and the reasoning

C. T-cell mediated autoimmune destruction of haematopoietic stem cells

Most acquired aplastic anaemia is idiopathic and is mediated by activated cytotoxic T cells that release interferon-gamma and TNF, causing destruction of stem cells. Treatment is stem cell transplantation for young patients with a matched donor, or immunosuppression with antithymocyte globulin and cyclosporine. Telomere defects and drugs such as chloramphenicol are other causes.

Option by option

  • A. Clonal ineffective haematopoiesis with a hypercellular marrow

    Ineffective haematopoiesis occurs in myelodysplastic syndromes, where the marrow is typically hypercellular.

  • B. Peripheral destruction of cells by an enlarged spleen

    Hypersplenism needs an enlarged spleen, and the marrow would be cellular.

  • C. T-cell mediated autoimmune destruction of haematopoietic stem cells (correct)

    Correct. Autoimmune T-cell attack on progenitors leaves an empty fatty marrow.

  • D. Replacement of marrow by fibrous tissue

    Marrow fibrosis occurs in myelofibrosis, with teardrop cells and a dry tap, and usually splenomegaly.

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 C, T-cell mediated autoimmune destruction of haematopoietic stem cells. Most acquired aplastic anaemia is idiopathic and is mediated by activated cytotoxic T cells that release interferon-gamma and TNF, causing destruction of stem cells.

Why is "Clonal ineffective haematopoiesis with a hypercellular marrow" not the answer?

Ineffective haematopoiesis occurs in myelodysplastic syndromes, where the marrow is typically hypercellular.

Why is "Peripheral destruction of cells by an enlarged spleen" not the answer?

Hypersplenism needs an enlarged spleen, and the marrow would be cellular.

Why is "Replacement of marrow by fibrous tissue" not the answer?

Marrow fibrosis occurs in myelofibrosis, with teardrop cells and a dry tap, and usually splenomegaly.

What concept does this question test?

It tests Haematology: aplastic anaemia in Pathology. Treatment is stem cell transplantation for young patients with a matched donor, or immunosuppression with antithymocyte globulin and cyclosporine. Telomere defects and drugs such as chloramphenicol are other causes.

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 Haematology: aplastic anaemia?

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.