ATI RN
Anatomy of Hematologic System Questions
Question 1 of 5
Which statement is correct regarding lymphocyte counts in infants versus adults?
Correct Answer: C
Rationale: The correct answer is C because T-cell numbers in infants are indeed higher than in adults. This is due to the active development of the immune system in infants, leading to a higher proportion of T-cells. A is incorrect because NK-cell numbers in infants are actually higher at birth and decrease with age. B is incorrect because B-cell numbers are lower at birth and increase with age. D is incorrect because infants do not have low lymphocyte counts; their immune system is actively developing, leading to higher lymphocyte counts compared to adults.
Question 2 of 5
You have a new patient consult in clinic this morning. The referral packet includes the newborn screen report, which is flagged abnormal hemoglobinopathy screen, F, A, Bart's, refer to hematology, and a complete blood count done at 4 years of age with a hemoglobin of 10 g/dL and an MCV of 68. The pediatrician has informed the parents the child has some form of alpha thalassemia. The older brother had the same newborn screen results but had a normal complete blood count when checked. The mother wants to know why her second child has an abnormal complete blood count when she and her husband do not have any blood problems. How would you respond to the child's mother?
Correct Answer: A
Rationale: Rationale for correct answer A: 1. Both parents must be carriers for the child to have alpha thalassemia. 2. The child has an abnormal complete blood count, indicating a hemoglobinopathy. 3. The child inherited a trans-deletion genotype alpha thalassemia trait from both parents. 4. Silent carriers have no symptoms but can pass on the trait. Summary for incorrect choices: B: In cis deletion, both parents would have to pass on the trait, which is not the case here. C: Spontaneous mutation is unlikely for alpha thalassemia. D: Both parents having cis deletions would result in a more severe form of alpha thalassemia.
Question 3 of 5
A 4-year-old girl with a history of recurrent epistaxis and easy bruising is referred to you for evaluation. She is found to have a prolonged PTT and a factor VIII level that is less than 1%. Both parents have a history of excessive bleeding. She is admitted with a severe episode of epistaxis, and your colleague orders 40 IU/kg of recombinant factor VIII. Her epistaxis resolves initially but within an hour starts again at the same severity as before. What is the best next step?
Correct Answer: A
Rationale: The correct answer is A: Infuse a von Willebrand factor concentrate. In this case, the 4-year-old girl with a factor VIII deficiency did not respond to recombinant factor VIII, suggesting a possible von Willebrand disease (vWD) as well. Infusing von Willebrand factor concentrate can help address the underlying vWD component, which is necessary for adequate hemostasis. Option B is incorrect because giving another dose of recombinant factor VIII won't address the potential vWD deficiency. Option C is not the best next step as packing the nose does not address the underlying bleeding disorder. Option D is not the immediate next step as checking for a factor VIII inhibitor is important but can be done after addressing the acute bleeding episode with appropriate therapy.
Question 4 of 5
A 14-year-old male patient is diagnosed with very high risk acute lymphoblastic leukemia and is likely going to require an allogeneic hematopoietic stem cell transplant to cure his leukemia. Prior to going to transplant, he is likely to require multiple blood transfusions. Which of the following products or component modifications is the best way to prevent him from developing alloimmunization due to anti-HLA antibodies prior to transplant?
Correct Answer: D
Rationale: The correct answer is D: Leukoreduced blood products. Leukoreduction removes white blood cells, which are a major source of HLA antigens that can trigger alloimmunization. By using leukoreduced blood products, the risk of developing anti-HLA antibodies is significantly reduced, thus minimizing the potential for alloimmunization prior to transplant. A: Frozen RBCs - Freezing does not eliminate HLA antigens and does not prevent alloimmunization. B: Volume-reduced blood products - Reducing volume does not impact HLA antigens and thus doesn't prevent alloimmunization. C: Irradiation of all blood products - While irradiation prevents graft-versus-host disease, it does not directly prevent the development of anti-HLA antibodies.
Question 5 of 5
A 20-month-old otherwise healthy male presents late for his 18-month well child check. During his first year of life, he took iron-fortified formula and had a point-of-care hemoglobin (Hgb) of 12 g/dL at his 1-year well child check. His mother reports that he is a picky eater but loves milk and has recently become obsessive about chewing the corners of his cardboard books. Physical examination is normal except for a flow murmur. Which combination of laboratory test results listed below would most likely characterize this patient?
Correct Answer: A
Rationale: The correct answer is A because it indicates iron deficiency anemia. The low Hgb of 8.7 g/dL is below normal range for his age. The MCV of 60 fL is low, indicating microcytic anemia which is characteristic of iron deficiency. The serum ferritin level of 2 ng/mL is very low, supporting the diagnosis. Choice B is incorrect as the Hgb and MCV are within normal range, and the ferritin level is not indicative of iron deficiency. Choice C has a low Hgb but normal MCV and ferritin level. Choice D has a normal Hgb and low ferritin, but the MCV is high, inconsistent with iron deficiency anemia.