Haematology: haemoglobin H inclusions: 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: haemoglobin H inclusions

Sample item

A 20-year-old man has mild jaundice, splenomegaly and haemoglobin 8.5 g/dL with microcytic hypochromic red cells. Electrophoresis shows a fast-migrating band. After incubating fresh blood with brilliant cresyl blue, many red cells contain multiple small blue inclusions giving a golf-ball appearance. What do these inclusions represent?

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

The answer and the reasoning

B. Precipitated beta-globin tetramers

In the intermediate form of alpha thalassaemia, excess beta chains form unstable tetramers that precipitate in ageing red cells. They are seen only with supravital stains such as brilliant cresyl blue and give the golf-ball picture.

Option by option

  • A. Nuclear DNA remnants

    Howell-Jolly bodies are single nuclear DNA remnants, seen after splenectomy, and are visible on a routine film.

  • B. Precipitated beta-globin tetramers (correct)

    Correct. Excess beta chains form unstable tetramers that precipitate and stain supravitally as multiple small inclusions.

  • C. Denatured haemoglobin on the membrane

    Heinz bodies are oxidised, denatured haemoglobin, usually one or two large inclusions attached to the membrane.

  • D. Aggregated ribosomal RNA

    Basophilic stippling is aggregated ribosomal RNA and is visible on a routine Romanowsky-stained film.

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, Precipitated beta-globin tetramers. In the intermediate form of alpha thalassaemia, excess beta chains form unstable tetramers that precipitate in ageing red cells.

Why is "Nuclear DNA remnants" not the answer?

Howell-Jolly bodies are single nuclear DNA remnants, seen after splenectomy, and are visible on a routine film.

Why is "Denatured haemoglobin on the membrane" not the answer?

Heinz bodies are oxidised, denatured haemoglobin, usually one or two large inclusions attached to the membrane.

Why is "Aggregated ribosomal RNA" not the answer?

Basophilic stippling is aggregated ribosomal RNA and is visible on a routine Romanowsky-stained film.

What concept does this question test?

It tests Haematology: haemoglobin H inclusions in Pathology. They are seen only with supravital stains such as brilliant cresyl blue and give the golf-ball picture.

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: haemoglobin H inclusions?

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.