hemo quiz

A 30-year-old male patient is diagnosed with Hodgkin lymphoma. Initial lab work reveals a WBC of 20 × 109/L, hemoglobin of 10.1 gm/dL, a serum albumin of 3 g/dL, and lymphopenia of 0.5 × 109/L. Staging studies identify stage III disease. What is this patient's prognostic score?

4 Response Feedback: Risk factors for lymphoma include age >45 years, male gender, serum albumin 15, and lymphopenia

You examine a 57-year-old woman with rheumatoid arthritis who is on a biological disease-modifying antirheumatic drug (DMARD) but continues to have poor disease control, and you find the following results on hemogram: Hgb = 10.5 g/dL Hct = 33% RBC = 3.1 million mm3 MCV = 88 fL MCHC = 32.8 g/dL RDW = 12.2% Reticulocytes = 0.8% The laboratory findings are most consistent with:

ACD. Response Feedback: When making a differential diagnosis, it is important to consider all patient factors. The presence of a normocytic (as per Wintrobe's classification), normochromic anemia would suggest ACD. This is consistent with the presence of a chronic inflammatory condition that is not well controlled with medication. Reticulocytopenia also suggests a poor hematological response related to a chronic condition.

What is the most common type of cancer in young children?

Acute lymphoblastic leukemia Response Feedback: Acute lymphoblastic leukemia, a malignancy of the bone marrow, is the most common type of cancer in children. It is more common in boys and in children between the ages of 2 and 4 years. Aplastic anemia is bone marrow suppression (not cancer) usually caused by medications or a viral infection. Multiple myeloma and non-Hodgkin's lymphoma are more common in older adults.

Which hematologic finding would be expected in an 18-month-old patient diagnosed with beta thalassemia minor?

Decreased hemoglobin A Response Feedback: Decreased hemoglobin A is associated with beta thalassemia minor. The red blood cells in beta thalassemia are hypochromic. A decrease in mean corpuscular volume and mean corpuscular hemoglobin concentration are associated with beta thalassemia.

What is the most common type of hemophilia in the United States?

Factor VIII deficiency Response Feedback: Factor VIII deficiency (hemophilia A) is a genetic disorder that is X-linked recessive. It is the most common type of hemophilia in the United States.

A Black adult male presents with new onset of jaundice, dark urine, fatigue, and anorexia. He was seen a few days previously and treated for a possible urinary tract infection. He is on the third day of nitrofurantoin (Macrobid) 100 mg PO BID 7 days. The hemoglobin is 11 g/dL, and hematocrit is 34%. The MCV is 84 fL. The serum indirect bilirubin is elevated. Which of the following conditions is most likely?

G6PD anemia Response Feedback: The patient probably has G6PD anemia, a type of hemolytic anemia. Exposure to certain drugs (e.g., sulfa, nitrofurantoin, dapsone) or foods (fava beans) can cause acute hemolysis because these substances cause oxidative damage to the red blood cell. In the United States, it is seen mostly in Black males or males of African descent. The elevation in the indirect bilirubin levels is caused by hemolysis of RBCs.

Which of the following is not consistent with ACD?

Hct less than 24% Response Feedback: ACD is characterized by a normocytic, normochromic anemia. This is due to a reduced erythropoietic response in the bone marrow resulting in RBC hypoproliferation. However, anemia seldom reaches severe status, with Hct at or above 24%. ACD is characterized by a normocytic, normochromic anemia. As this is not an evolving anemia, RDW is within normal limits. Micronutrient deficiency is not an issue in ACD, thus ferritin levels and Hgb production (MCHC) are within normal levels.

Which of the following tests would you recommend to patients to confirm the diagnosis of beta thalassemia or sickle cell anemia?

Hemoglobin electrophoresis Response Feedback: Patients with the diagnosis of beta thalassemia and/or sickle cell anemia would be screened using hemoglobin electrophoresis to identify the blood disorder.

A male patient has a history of recurrent epistaxis. Prior to a scheduled surgery, the provider asks about a family history of bleeding disorders. The patient reports no female relatives who had excessive bleeding episodes, but states that a maternal uncle and his maternal grandfather both had postsurgical complications related to bleeding. Based on this history, which diagnosis is possible?

Hemophilia Response Feedback: Hemophilia is an X-linked recessive disorder affecting only males and carried by females. A family history of maternal males with bleeding disorders should clue the provider that this disorder is likely. Thrombocytopenia is usually an acquired disorder. Thrombophilia causes clots and thrombi, not bleeding. Von Willebrand disease is an autosomal genetic disorder affecting both males and females.

A 18-year-old college freshman presents at the campus clinic with reports of severe night sweats, lymphadenopathy, and severe pain over gland areas after drinking alcohol. Further assessment indicates that the patient has a positive Pel-Ebstein sign. Blood work reveals several Reed-Sternberg cells. Which diagnosis is most likely?

Hodgkin's lymphoma Response Feedback: Hodgkin's lymphoma is typically diagnosed between the ages of 15 and 19 years. Patients present with enlarged cervical, axillary, and supraclavicular lymphadenopathy with fluctuating days of fever and no fever. Leukemia causes extreme fatigue, weakness, pale skin, and easy bruising. Some patients will experience petechiae. ALL is a fast-growing cancer of lymphoblasts that causes very high white blood cell (WBC) counts (>50,000 cells). AML is also a fast-growing cancer of the bone marrow; it affects immature WBCs, macrophages/monocytes, red blood cells (RBCs), and platelets.

A patient is suspected of having leukemia and the provider orders biochemical studies and a bone marrow aspirate and biopsy. The results include white blood cells (WBCs) greater than 200,000 cells/mm3 normal red blood cells (RBCs), hyperplastic myeloid cells, and the absence of serum leukocyte alkaline phosphatase. Which test will the provider order to confirm a diagnosis in this patient?

Philadelphia chromosome test Response Feedback: The findings from the complete blood count (CBC) and bone marrow biopsy, along with a positive Philadelphia chromosome test, confirm the diagnosis of chronic myelogenous leukemia. A chest radiograph and serum protein electrophoresis may be performed to evaluate for associated symptoms. Coagulation studies are usually performed as part of the diagnostic workup for acute lymphocytic leukemia (ALL).

A child has a recent history of leg pain, unexplained bruising, and nosebleeds. The provider notes petechiae and diffuse lymphadenopathy. A complete blood count reveals a white blood cell (WBC) of 30,000 cells/mm3 and near normal red blood cell (RBC) and platelet counts. What will the provider do next to manage this patient?

Refer to a specialist for a bone marrow aspirate and biopsy Response Feedback: Patients with acute lymphocytic leukemia (ALL) may have normal blood counts even when the marrow has been replaced with leukemic cells, so a bone marrow aspirate and biopsy is required for the definitive diagnosis. Coagulation and biochemical studies may be performed after the diagnosis is known to evaluate for complications. Waiting and repeating the CBC in 2 weeks is not recommended since the definitive diagnosis is made by bone marrow biopsy.

The nurse practitioner is reviewing the medical record of a 6-month-old infant with normocytic hemolytic anemia and notes an electrophoresis result of hemoglobin S with a 20% concentration of hemoglobin F (fetal hemoglobin). Which additional diagnosis is most likely?

Sickle cell anemia Response Feedback: A patient with normocytic hemolytic anemia who has electrophoresis results of hemoglobin S with a 20% concentration of hemoglobin F has sickle cell anemia. Electrophoresis is not used to diagnose hemolytic or aplastic anemia. Thalassemia major appears within the first 2 years of life and is associated with life-threatening anemia. Thalassemia major is associated with nonhemolytic, normocytic anemia.

Which hematologic findings on a peripheral smear support a diagnosis of sickle cell anemia?

Target cells Response Feedback: Target cells and Howell-Jolly bodies are found on a peripheral smear in patients with sickle cell anemia. Burr cells and schistocytes are cell shapes categorized as poikilocytosis. Anisopoikilocytosis is associated with beta thalassemia major, not sickle cell anemia.

A 40-year-old woman with pyelonephritis is taking two medications: ciprofloxacin and ferrous sulfate (for IDA). She asks about taking both medications. You advise that:

an inactive drug compound is potentially formed if the two medications are taken together.

Which of the following is most consistent with IDA?

low MCV, low MCH

You examine a 27-year-old woman with menorrhagia who is otherwise well and note the following results on hemogram: Hgb = 10.1 g/dL Hct = 32% RBC = 2.9 million mm3 MCV = 72 fL MCHC = 28.2 g/dL RDW = 18.9% Physical examination is likely to include:

no specific anemia-related findings. Response Feedback: Anemia in a patient with menorrhagia is likely due to IDA from chronic low-volume blood loss. However, in mild anemia, symptoms may not be evident, and physical examination usually contributes little to the diagnosis.

A 68-year-old man who is usually healthy presents with new onset of "huffing and puffing" with exercise for the past 3 weeks. Physical examination reveals conjunctiva pallor and a hemic murmur. Hemogram results are as follows: Hgb = 7.6 g/dL Hct = 20.5% RBC = 2.1 million mm3 MCV = 76 fL MCHC = 28 g/dL RDW = 18.4% Reticulocytes = 1.8% The most likely cause of these findings is:

occult blood loss. A microcytic, hypochromic anemia with elevated RDW is most consistent with IDA. A common cause of IDA is chronic, low-volume blood loss.

Which of the following conditions is unlikely to result in ACD?

peripheral vascular disease Response Feedback: ACD is associated with a number of chronic health conditions, including renal disease, inflammation, and infection. Peripheral vascular disease is not typically associated with ACD. ACD is caused by reduced erythropoietin response in the marrow. Select chronic conditions include chronic inflammation (rheumatoid arthritis) and infection (HIV, osteomyelitis). Chronic renal insufficiency is also a major contributor to ACD as this can lead to decreased production of endogenous erythropoietin that stimulates reticulocytosis.

A 48-year-old woman developed IDA after excessive perimenopausal vaginal bleeding, successfully treated by endometrial ablation. Her Hct level is 25%, and she is taking iron therapy. At 5 days into therapy, one possible observed change in laboratory parameters would include:

reticulocytosis

You examine a 22-year-old woman of Asian ancestry. She has no presenting complaint. Hemogram results are as follows: Hgb = 9.1 g/dL (normal 12 to 14 g/dL) Hct = 28% (normal 36% to 43%) RBC = 5.6 million mm3 (normal 4.2 to 5.4 million mm3) MCV = 68 fL (normal 81 to 96 fL) MCHC = 33.2 g/dL (normal 31 to 37 g/dL) RDW = 13% (normal ≤15%) Reticulocytes = 1.5% (normal 1% to 2%) This is most consistent with the laboratory assessment of:

α-thalassemia minor. Response Feedback: Asian and African ethnicities are at risk for α-thalassemia minor, which is characterized by microcytic RBCs, normal RDW, and an elevated number of RBCs. Among the answer choices, the diagnostic findings were most consistent with α-thalassemia minor.