Which of the following is not a good prognostic factor in patient with acute lymphoblastic leukemia?

Correct Answer: A

Rationale: The correct answer is A: Immunophenotype - mature B cell. In acute lymphoblastic leukemia, a mature B cell immunophenotype is associated with a poor prognosis due to its resistance to treatment. Gender being female is a good prognostic factor as females tend to have better outcomes. Hyperploidy is favorable as it indicates a better response to treatment. Age 4 to 10 years old is also a good prognostic factor as younger age groups have better survival rates.

Correct Answer: A

Rationale: The correct answer is A: Low total iron binding capacity. In this case, the patient is showing signs of iron deficiency anemia. Low total iron binding capacity is not expected because in iron deficiency anemia, the total iron binding capacity is typically elevated as the body tries to increase its capacity to bind and transport iron. High serum transferrin and low iron: total iron binding capacity ratio are expected findings in iron deficiency anemia, as the body increases the production of transferrin to compensate for low iron levels. Low serum ferritin is also expected as it is a marker of decreased iron stores in the body. Therefore, choice A is the correct answer as it contradicts the typical laboratory findings seen in iron deficiency anemia.

Correct Answer: B

Rationale: Rationale for Choice B: Defects in the peripheral proteins are the most likely cause of spherocytosis. Spherocytosis is characterized by spherical-shaped red blood cells due to a deficiency in peripheral membrane proteins like spectrin, leading to reduced cell flexibility and membrane stability. This results in premature destruction of red blood cells in the spleen, causing hemolytic anemia. Summary: A: Abnormal antigenic properties are not the primary cause of spherocytosis; the issue lies in membrane protein defects. C: Increased formation of ropalux is not a known factor in spherocytosis. D: Formation of sickle-shaped cells is characteristic of sickle cell anemia, not spherocytosis.

Correct Answer: D

Rationale: The correct answer is D: RA with excess blasts in transformation. This choice has the poorest prognosis because it represents a progression of RA with excess blasts, indicating a higher percentage of blast cells in the bone marrow. This progression signifies a more aggressive form of the disease with a worse outcome. A: Refractory anemia (RA) is a milder form with a better prognosis compared to the other choices. B: RA with ring sideroblasts is a subtype of RA, and while it may have some adverse features, it generally has a better prognosis than RA with excess blasts. C: RA with excess blasts represents a higher risk group, but it is not as severe as RA with excess blasts in transformation, which indicates a further deterioration of the disease. In summary, D is the correct answer because it signifies the most advanced stage of the disease with the highest risk and poorest prognosis compared to the other choices.

Correct Answer: C

Rationale: The correct answer is C, chronic myelocytic leukemia. The presence of increased numbers of neutrophils at various stages of maturation, along with increased basophils, eosinophils, and platelets, is characteristic of chronic myelocytic leukemia. This condition is marked by a myeloproliferative disorder, leading to an overproduction of myeloid cells in the bone marrow. Acute myeloid leukemia (choice A) typically presents with a high number of blast cells rather than mature neutrophils. Acute lymphoid leukemia (choice B) primarily involves lymphoid cells, not myeloid cells. Chronic lymphocytic leukemia (choice D) is characterized by the accumulation of mature lymphocytes, not myeloid cells as seen in this case.