Haematology: Evans syndrome: 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: Evans syndrome

Sample item

A 30-year-old woman has jaundice and petechiae. Haemoglobin is 7 g/dL, reticulocytes are raised, platelets are 20,000 per microlitre and the smear shows spherocytes without schistocytes. The direct antiglobulin test is positive, and PT, aPTT and fibrinogen are normal. What is the diagnosis?

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

The answer and the reasoning

D. Evans syndrome

Evans syndrome is autoimmune haemolytic anaemia together with immune thrombocytopenia, so the direct antiglobulin test is positive, spherocytes are present and coagulation tests are normal. Thrombotic microangiopathies and DIC cause schistocytes and a negative antiglobulin test, with DIC also prolonging clotting times.

Option by option

  • A. Haemolytic uraemic syndrome

    HUS has schistocytes with renal failure and a negative DAT.

  • B. Disseminated intravascular coagulation

    DIC prolongs PT and aPTT with low fibrinogen, which are normal here.

  • C. Thrombotic thrombocytopenic purpura

    TTP has schistocytes and a negative DAT, caused by ADAMTS13 deficiency.

  • D. Evans syndrome (correct)

    Correct. A positive DAT with haemolysis and thrombocytopenia, and normal coagulation, indicates Evans syndrome.

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 D, Evans syndrome. Evans syndrome is autoimmune haemolytic anaemia together with immune thrombocytopenia, so the direct antiglobulin test is positive, spherocytes are present and coagulation tests are normal.

Why is "Haemolytic uraemic syndrome" not the answer?

HUS has schistocytes with renal failure and a negative DAT.

Why is "Disseminated intravascular coagulation" not the answer?

DIC prolongs PT and aPTT with low fibrinogen, which are normal here.

Why is "Thrombotic thrombocytopenic purpura" not the answer?

TTP has schistocytes and a negative DAT, caused by ADAMTS13 deficiency.

What concept does this question test?

It tests Haematology: Evans syndrome in Pathology. Thrombotic microangiopathies and DIC cause schistocytes and a negative antiglobulin test, with DIC also prolonging clotting times.

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: Evans syndrome?

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.