Haematology: Waldenstrom macroglobulinaemia: 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.

Try it

Pathology · Haematology: Waldenstrom macroglobulinaemia

Sample item

A 68-year-old man has fatigue, epistaxis, blurred vision and dilated retinal veins. Serum IgM is 5 g/dL, and marrow shows lymphoplasmacytic infiltration with a MYD88 L265P mutation. There are no lytic bone lesions. Which intervention gives urgent relief of his symptoms?

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

The answer and the reasoning

D. Plasmapheresis

Waldenstrom macroglobulinaemia is a lymphoplasmacytic lymphoma secreting IgM, a large pentamer that raises plasma viscosity. Hyperviscosity causes mucosal bleeding, visual disturbance and neurological symptoms, and plasmapheresis removes IgM quickly because it is mostly intravascular. Chemotherapy or targeted therapy then controls the clone, and transfusion before plasmapheresis can worsen viscosity.

Option by option

  • A. Red cell transfusion

    Transfusion increases blood viscosity further and can worsen symptoms.

  • B. Radiotherapy to the skeleton

    Skeletal radiotherapy treats painful lytic lesions, which are absent.

  • C. Intravenous saline with a bisphosphonate

    Hydration and bisphosphonates treat hypercalcaemia of myeloma, which is not the problem here.

  • D. Plasmapheresis (correct)

    Plasmapheresis rapidly removes the intravascular IgM causing hyperviscosity.

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.

More Pathology questions

Questions about this Pathology question

What is the answer to this Pathology question?

The best answer is D, Plasmapheresis. Waldenstrom macroglobulinaemia is a lymphoplasmacytic lymphoma secreting IgM, a large pentamer that raises plasma viscosity.

Why is "Red cell transfusion" not the answer?

Transfusion increases blood viscosity further and can worsen symptoms.

Why is "Radiotherapy to the skeleton" not the answer?

Skeletal radiotherapy treats painful lytic lesions, which are absent.

Why is "Intravenous saline with a bisphosphonate" not the answer?

Hydration and bisphosphonates treat hypercalcaemia of myeloma, which is not the problem here.

What concept does this question test?

It tests Haematology: Waldenstrom macroglobulinaemia in Pathology. Hyperviscosity causes mucosal bleeding, visual disturbance and neurological symptoms, and plasmapheresis removes IgM quickly because it is mostly intravascular. Chemotherapy or targeted therapy then controls the clone, and transfusion before plasmapheresis can worsen viscosity.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: Waldenstrom macroglobulinaemia?

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.