Which of the following is not associated with thrombotic thrombocytopenic purpura?

Correct Answer: A

Rationale: The correct answer is A: Thrombosis. Thrombotic thrombocytopenic purpura (TTP) is characterized by microangiopathic hemolytic anemia and thrombocytopenia, not thrombosis. In TTP, there is excessive platelet aggregation leading to microthrombi formation in small blood vessels, causing hemolysis and thrombocytopenia. Neurologic deficits are also common due to microvascular ischemia. Thrombosis is not a typical feature of TTP and is more commonly associated with conditions like deep vein thrombosis or pulmonary embolism. Thrombosis is not a hallmark of TTP, making choice A the correct answer.

Correct Answer: A

Rationale: The correct answer is A: Nodular sclerosis. This subtype of Hodgkin's lymphoma is more common in young women and has a good prognosis due to its characteristic fibrotic bands dividing the lymph node into nodules. These nodules contain a mixture of inflammatory cells and Reed-Sternberg cells. Choice B: Mixed cellularity is more common in older patients and has a less favorable prognosis due to its heterogeneous cell population with abundant Reed-Sternberg cells. Choice C: Lymphocyte predominance typically affects young adults and has an indolent course with a good prognosis, but it is not as common in young women as nodular sclerosis. Choice D: Lymphocyte depletion is a rare subtype seen in older individuals with a poor prognosis due to the paucity of lymphocytes and an abundance of Reed-Sternberg cells.

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.