Hematology 1 & 2

Easy round

Hematology 1 & 2

Multiple Choice

Insufficient centrifugation will result in:

• A false increase in hematocrit (HCT) value

• A false decrease in HCT value

• No effect on HCT value

• All of these options, depending on the patient

Insufficient centrifugation does not pack down RBCs; therefore, the HCT, which is the volume of packed red cells, will increase.

A - A false increase in hct value

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

All of the following factors may influence the erythrocyte sedimentation rate (ESR) except:

• Blood drawn form sodium citrate tube

• Anisocytosis, poikilocytosis

• Plasma proteins

• Caliber of the tube

• EDTA and sodium citrate can be used without any effect on the ESR.

• Anisocytosis and poikilocytosis may impede rouleaux formation thus causing low ESR.

• Plasma proteins, especially fibrinogen an immunoglobulins, enhance rouleaux , increasing the ESR.

• Reference ranges mus be established for tubes of different calibers

A - Blood drawn into a sodium citrate tube

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

What is the major type of leukocyte seen in the peripheral blood smear from a patient with aplastic anemia?

• Segmented neutrophil

• Lymphocyte

• Monocyte

• Eosinophil

B - leukocyte

In aplastic anemia, lymphocytes constitute the majority of the nucleated cells seen. In aplastic anemia, bone marrow is spotty, with patches of normal cellularity. Absolute granulocytopenia is usually present; however

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which of the following is considered normal Hgb?

• Carboxyhemoglobin

• Methemoglobin

• Sulfhemoglobin

• Deoxyhemoglobin

d - deoxyhemoglobin

Deoxyhemoglobin is the physiological Hgb that results from the unloading of O2 by Hgb. This is accompanied by the widening of the space between beta chains and the binding of 2,3-DPG on a mole-for-mole basis.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which of the following is the preferred site for bone marrow aspiration and biopsy in an adult?

• Iliac crest

• Sternum

• Tibia

• Spinous processes of a vertebrae

a - iliac crest

The Iliac crest is the most frequently used site for bone marrow aspiration and biopsy. This site is the safest and most easily accessible, with the bone being just beneath the skin, and neither blood vessels nor nerves are in the vicinity.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which if the following organs is responsible for "pitting process" in RBCs?

• Liver

• Spleen

• Kidney

• Lymph Nodes

b - spleen

The spleen is the supreme filter of the body, pitting imperfections from the erythrocyte without destroying the integrity of the membrane

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

The autohemolysis test result is positive in all of the following conditions except:

• G6PD deficiency

• HS

• PK deficiency

• PNH

d - pnh

The autohemolysis test is positive in Glucose-6-phosphate dehydrogenase deficiency, pyruvate kinase deficiencies, and hereditary spherocytosis but is normal in Paroxysmal nocturnal hemoglobinuria because lysis in PNH requires sucrose to enhance complement binding.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which antibody is associated with paroxysmal cold hemoglobinuria (PCH)?

• Anti - I

• Anti - i

• Anti - M

• Anti - P

d - Anti - p

PCH is caused by the anti-P antibody, a cold

autoantibody that binds to the patient’s RBCs at

low temperatures and fixes complement. In the

classic Donath–Landsteiner test, hemolysis is

demonstrated in a sample placed at 4°C that is

then warmed to 37°C.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which of the following properties renders the vessel wall prothrombotic?

• negatively charged surface

• Production of prostacyclin and nitric oxide

• Release of tissue factor

• Inactivation of thrombin

c - Release of tissue factor

Under normal circumstances, vessels are nonthrombotic. Factors that contribute to this include a negatively charged surface; the inhibition of platelet activation through prostacyclin, nitric oxide, and ADPase; and the inactivation of thrombin through heparin sulfate and thrombomodulin. Once damaged, tissue factor is one of the substances released that favors the formation of clots. Other prothrombotic substances include the secretion of platelet-activating factor and von Willebrand factor.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

All of the following are associated with intravascular hemolysis except:

• Methemoglobinemia

• Hemoglobinuria

• Hemoglobinemia

• Decreased haptoglobin

a - methemoglobinemia

Methemoglobin occurs when iron is oxidized to the ferric state. Normally, iron is predominantly in the ferrous state in the hemoglobin that circulates. During intravascular hemolysis, the red cells rupture, releasing hemoglobin directly into the bloodstream. Haptoglobin is a protein that binds to free Hgb. The

increased free Hgb in intravascular hemolysis causes depletion of haptoglobin. As haptoglobin is depleted, unbound hemoglobin dimers appear in the plasma

(hemoglobinemia) and are filtered through the kidneys and reabsorbed by the renal tubular cells. The renal tubular uptake capacity is approximately 5 g per day of filtered hemoglobin. Beyond this level, free hemoglobin appears in the urine (hemoglobinuria). Hemoglobinuria is associated with hemoglobinemia.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which of the following is the primary Hgb in patients with thalassemia major?

• Hgb D

• Hgb A

• Hgb C

• Hgb F

d - Hgb f

Patients with thalassemia major are unable to

synthesize the β-chain; hence, little or no Hgb A

is produced. However, γ-chains continue to be

synthesized and lead to variable elevations of Hgb F

in these patients.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

In which of the following conditions is Hgb A2 elevated?

• Hgb H

• Hgb SC disease

• Beta thalassemia minor

• Hgb S trait

c - beta thalassemia minor

Hgb A2 is part of the normal complement of adult

Hgb. This Hgb is elevated in β-thalassemia minor

because the individual with this condition has only

one normal β-gene; consequently, there is a slight

elevation of Hgb A2 and Hgb F.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which inclusions may be seen in leukocytes?

A. Döhle bodies

B. Basophilic stippling

C. Malarial parasites

D. Howell–Jolly bodies

• Dohle bodies

• Basophilic stippling

• Malarial parasites

• Howell-Jolly bodies

a - Dohle bodies

Döhle bodies are RNA-rich areas within

polymorphonuclear neutrophils (PMNs) that are

oval and light blue in color. Although often

associated with infectious states, they are seen in

a wide range of conditions and toxic reactions,

including hemolytic and pernicious anemias,

chronic granulocytic leukemia, and therapy with

antineoplastic drugs. The other inclusions are

associated with erythrocytes.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which of the morphological findings are characteristic of reactive lymphocytes?

• High N:C ratio

• Prominent nucleoli

• Basophilic cytoplasm

• All of these options

d- all of these options

Both reactive lymphocytes and blasts may have

basophilic cytoplasm, a high N:C ratio, and the

presence of prominent nucleoli. Blasts, however,

have an extremely fine nuclear chromatin staining

pattern as viewed on a Wright’s–Giemsa’s—stained

smear.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Auer rods may be seen in all of the following except:

• Acute myelomonocytic leukemia

• Acute lymphoblastic leukemia

• Acute myeloid leukemia without maturation

• Acute promyelocytic leukemia

b - Acute lymphoblastic leukemia

Auer rods are not seen characteristically in

lymphoblasts. They may be seen in myeloblasts,

promyelocytes, and monoblasts.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

The basic pathophysiological mechanisms responsible for producing signs and symptoms in leukemia include all of the following except:

• Replacement of normal marrow precursors by leukemic cells causing anemia

• Decrease in functional leukocytes causing

  infection

• Hemorrhage secondary to thrombocytopenia

• Decreased erythropoietin production

d - Decreased erythropoietin production

A normal physiological response to anemia would

be an increase in the kidney’s production of

erythropoietin. The accumulation of leukemic cells

in the bone marrow leads to marrow failure, which

is manifested by anemia, thrombocytopenia, and

granulocytopenia.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Which of the following is a characteristic of Auer rods?

• They are composed of azurophilic granules

• They stain periodic acid–Schiff (PAS) positive

• They are predominantly seen in chronic myelogenous leukemia (CML)

• They are nonspecific esterase positive

a - They are composed of azurophilic granules

Auer rods are a linear projection of primary

azurophilic granules, and are present in the

cytoplasm of myeloblasts and monoblasts in

patients with acute leukemia.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

Leukemic lymphoblasts reacting with anti-CALLA are characteristically seen in:

• B-cell ALL

• T-cell ALL

• Null-cell ALL

• Common ALL

d - common all

The majority of non-T, non-B ALL blast cells display

the common ALL antigen (CALLA) marker.

Lymphoblasts of common ALL are TdT positive and

CALLA positive but do not have surface membrane

IgM or μ chains and are pre-B lymphoblasts.

Common ALL has a lower relapse rate and better

prognosis than other immunologic subtypes of

B-cell ALL.

Harr, R. R. (2012). Medical Laboratory Science Review. F.A. Davis.

Multiple Choice

What sugar gives B specificity in the ABO system?

• N-acetylgalactosamine

• D-galactose

• L-fucose

• L-glucose

Multiple Choice

What is the shelf life of CPDA-1 preserved whole blood?

• 21 days at 1-6 C

• 35 days at -18 C

• 35 days at 1-6 C

• 42 days at -18 C

Multiple Choice

The alleged father of a child is blood group AB. The mother is group O, and the child is group O. What type of exclusion is this?

• Direct/Primary/First order

• Probability

• Random

• Indirect/Secondary/Second Order

Average round

Hematology 1 & 2

Multiple Choice

An absolute lymphocytosis with reactive lymphocytosis suggests which of the following conditions

• DiGeorge syndrome

• Bacterial Infection

• Parasitic Infection

• Viral Infection

d - Viral infection

Di George syndrome - low or absent T cells

Bacterial - neutrophils

Parasitic - Eosinophil

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

What leukocyte cytoplasmic inclusion is composed of ribosomal RNA?

• Primary granules

• Toxic granules

• Döhle bodies

• Howell-Jolly bodies

Multiple Choice

Which of the following conditions is not associated with secondary warm autoimmune hemolytic anemia?

• CLL

• Idiopathic onset

• Rheumatoid arthritis

• Viral infections

Multiple Choice

What leukocyte cytoplasmic inclusion is composed of ribosomal RNA?

• Primary granules

• Toxic granules

• Döhle bodies

• Howell-Jolly bodies

b - idiopathic onset

Idiopathic onset is an unknown cause of warm autoimmune hemolytic anemia (WAIHA). Secondary WAIHA is usually associated with chronic lymphoid disorders, viral infections, and autoimmune disorders.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Patients with renal failure often exhibit compromised hematopoietic activity because of which of the following?

• Concurrent depression of thyroid

  hormones

• Decreased production of erythropoietin

• Decreased production of GM-CSF

• Bone marrow suppression caused by medications

b - decreased production of erythropoietin

Erythropoiesis is stimulated by erythropoietin, which is produced in the kidney, and renal failure can decrease the production of erythropoietin.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Screening tests for thrombophilia should be performed on:

• All pregnant women because of the thrombotic

  risk

• Patients with a negative family history

• Patients with thrombotic events occurring at a young age

• Patients who are receiving anticoagulant therapy

c -Patients with thrombotic events occurring at a young age

Laboratory tests for evaluation of thrombophilia are

justified in young patients with thrombotic events,

in patients with a positive family history after a

single thrombotic event, in those with recurrent

spontaneous thrombosis, and in pregnancies

associated with thrombosis.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Factor V Leiden promotes thrombosis by

preventing:

• Deactivation of factor Va

• Activation of factor V

• Activation of protein C

• Activation of protein S

a - deactivation of factor va

Factor V Leiden is a single-point mutation in the

factor V gene that inhibits factor Va inactivation by

protein C. Activated protein C enhances deactivation

of factors Va and VIIIa.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Ecarin clotting time may be used to monitor:

• Heparin therapy

• Warfarin therapy

• Fibrinolytic therapy

• D. Hirudin therapy

d - hirudin therapy

Ecarin clotting time, a snake venom–based clotting assay, may be used to monitor hirudin therapy in instances when the baseline APTT is prolonged due

to lupus anticoagulant or factor deficiencies. The APTT is insensitive to hirudin levels above 0.6 mg/L, and this insensitivity may result in a drug overdose despite a monitoring protocol.
- Heparin therapy is monitored by the APTT;
- warfarin therapy is monitored by the INR.
- Fibrinolytic therapy may be monitored by D-dimer.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Which defect characterizes Gray’s syndrome?

• Platelet adhesion defect

• Dense granule defect

• Alpha granule defect

• Coagulation defect

c - alpha granule defect

Gray’s syndrome is a platelet granule defect

associated with a decrease in alpha granules resulting

in decreased production of alpha granule proteins

such as platelet factor 4 and beta thromboglobulin.

Alpha granule deficiency results in the appearance

of agranular platelets when viewed on a Wright’sstained

blood smear.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Bernard–Soulier syndrome is associated with:

• Decreased bleeding time

• Decreased factor VIII assay

• Thrombocytopenia and giant platelets

• Abnormal platelet aggregation to ADP

c - thrombocytopenia & giant platelets

Bernard–Soulier syndrome is associated with

thrombocytopenia and giant platelets. It is a

qualitative platelet disorder caused by the

deficiency of glycoprotein Ib. In Bernard–Soulier

syndrome, platelet aggregation to ADP is normal.

Aggregation in the platelet function assay is

abnormal. Factor VIII assay is not indicated for this

diagnosis.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Which of the following is not classified as a myeloproliferative neoplasm?

• Chronic eosinophilic leukemia

• Essential thrombocythemia

• Mastocytosis

• Waldenstrom’s macroglobulinemia

d - waldenstrom's macroglobulinemia

All are myeloproliferative neoplasms with the

exception of Waldenstrom’s macroglobulinemia,

which is a plasma cell disorder.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Thrombotic thrombocytopenic purpura (TTP) is

characterized by:

• Prolonged PT

• Increased platelet aggregation

• C. Thrombocytosis

• D. Prolonged APTT

b - increased platelet aggregation

Thrombotic thrombocytopenic purpura (TTP) is a

quantitative platelet disorder associated with

increased intravascular platelet activation and

aggregation resulting in thrombocytopenia. The

PT and APTT results are normal in TTP.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

If antiglobulin phase of the crossmatch is omitted, which of the following antibodies would probably not be detected?

• Anti - K

• Anti - A

• Anti - P1

• Anti - N

difficult round

Hematology 1 & 2

Multiple Choice

Patients with infectious mononucleosis often have the following CBC results:

• Lymphocytosis, including increased variant/

  reactive lymphocytes

• Lymphocytopenia with numerous small

  lymphocytes

• Neutrophilia, including a predominant shift to

  the left

• Neutropenia with a distinct predominance of

  toxic granulation

a - Lymphocytosis, including increased variant/

reactive lymphocytes

Patients with infectious mononucleosis often exhibit an increase in lymphocytes, along with the presence of reactive lymphocytes. Neutrophilia with a left shift is typically seen in bacterial infections or other acute infections

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

A 3-year-old male patient visits the pediatrician for a well-child checkup and routine CBC. He has a total WBC count of 5.0 x 10^9/L, RBC count of 3.8 x 10^12/L, and platelet count of 225 x 10^9/L. The differential showed 25% segmented neutrophils, 62% lymphocytes, 10% monocytes, and 3% eosinophils.
This patient is likely:

• A normal child

• Suffering from an acute bacterial infection

• Immunosuppressed

• A patient with leukemia

a - a normal child

This is most likely a normal child, because children usually have higher relative lymphocyte counts than adults. The patient has normal total white blood cell, red blood cell, and platelet counts and normal differential results.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

A dry tap may be seen in bone marrow aspirations in all of the following conditions except:

• Aplastic anemia

• Hairy cell leukemia

• Multiple myeloma

• Primary myelofibrosis

c - multiple myeloma

Fibrotic or hypercellular marrow is seen in all of the following except multiple myeloma, in which sheets of plasma cells may be present.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

A 30-year-old woman develops signs and

symptoms of thrombosis in her left lower leg

following 5 days of heparin therapy. The patient

had open-heart surgery 3 days previously and has

been on heparin ever since. Which of the following

would be the most helpful in making the

diagnosis?

• Fibrinogen assay

• Prothrombin time

• Platelet counts

• Increased heparin dose

c - platelet count

The platelet count should be checked every other day in patients receiving heparin therapy. Heparin-induced thrombocytopenia (HIT) should be suspected in patients who are not responding to heparin therapy and/or are developing thrombocytopenia (50% below the baseline value) and thrombotic complications while on heparin therapy. Increase in heparin dose should be avoided in patients with the clinical symptoms of thrombosis while they are receiving heparin. Fibrinogen assay and PT are not the appropriate assays for monitoring heparin therapy, nor are they used to test for HIT.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

The morphological characteristic(s) associated

with the Chédiak–Higashi syndrome is (are):

• Pale blue cytoplasmic inclusions

• Giant lysosomal granules

• Small, dark-staining granules and condensed

  nuclei

• Nuclear hyposegmentation

b - giant lysosomal granules

Chédiak–Higashi syndrome is a disorder of

neutrophil phagocytic dysfunction caused by

depressed chemotaxis and delayed degranulation.

The degranulation disturbance is attributed to

interference from the giant lysosomal granules

characteristic of this disorder.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

The familial condition of Pelger–Huët anomaly is important to recognize because this disorder must be differentiated from:

• Infectious mononucleosis

• May–Hegglin anomaly

• A shift-to-the-left increase in immature

  granulocytes

• G6PD deficiency

c -A shift-to-the-left increase in immature granulocytes

Pelger–Huët anomaly is a benign familial condition

reported in 1 out of 6,000 individuals. Care must be

taken to differentiate Pelger–Huët cells from the

numerous band neutrophils and metamyelocytes

that may be observed during severe infection or a

shift-to-the-left of immaturity in granulocyte stages.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

What would be the most likely designation

by the WHO for the FAB AML M3 by the

French–American–British classification?

• AML with t(15;17)

• AML with mixed lineage

• AML with t(8;21)

• AML with inv(16)

a - AML with t(15;17)

AML with t(15;17) is classified under the category of AML with Recurrent Genetic Abnormalities by the WHO. Acute promyelocytic leukemia (PML; known as M3 under the FAB system) is composed of abnormal promyelocytes with heavy granulation, sometimes obscuring the nucleus, and abundant cytoplasm.

Acute promyelocytic leukemia (APL) contains a translocation that results in the fusion of a transcription factor called PML on chromosome 15 with the alpha (α)-retinoic acid receptor gene (RARα) on chromosome 17.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Multiple myeloma is most difficult to distinguish from:

• Chronic lymphocytic leukemia

• Acute myelogenous leukemia

• Benign monoclonal gammopathy

• Benign adenoma

C - Benign monoclonal gammopathy

Benign monoclonal gammopathies have peripheral blood findings similar to those in myeloma. However, a lower concentration of monoclonal protein is

usually seen. There are no osteolytic lesions, and the plasma cells comprise less than 10% of nucleated cells in the bone marrow. About 30% become malignant, and therefore the term monoclonal gammopathy of undetermined significance (MGUS) is the designation used to describe this condition.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

In which of the following conditions does LAP show the least activity?

• Leukemoid reactions

• Idiopathic myelofibrosis

• PV

• CML

d - CMl

Chronic myelogenous leukemia shows the least LAP

activity, whereas the LAP score is slightly to markedly

increased in each of the other states.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

Repeated phlebotomy in patients with polycythemia vera (PV) may lead to the development of:

• Folic acid deficiency

• Sideroblastic anemia

• Iron deficiency anemia

• Hemolytic anemia

c - iron deficiency anemia

The most common treatment modality utilized in

PV is phlebotomy. Reduction of blood volume

(usually 1 unit of whole blood—450 cc), can be

performed weekly or even twice weekly in younger

patients to control symptoms. The Hct target range

is less than 45% for men, less than 42% for women.

Iron deficiency anemia is a predictable complication

of therapeutic phlebotomy because approximately

250 mg of iron is removed with each unit of blood.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

What influence does the Philadelphia (Ph1)

chromosome have on the prognosis of patients

with chronic myelocytic leukemia?

• It is not predictive

• The prognosis is better if Ph1 is present

• The prognosis is worse if Ph1 is present

• The disease usually transforms into AML when

  Ph1 is present

b - The prognosis is better if Ph1 is present

Ninety percent of patients with CML have the Philadelphia chromosome. This appears as a long arm deletion of chromosome 22, but is actually

a translocation between the long arms of chromosomes 22 and 9. The ABL oncogene from chromosome 9 forms a hybrid gene with the bcr region of chromosome 22. This results in production of a chimeric protein with tyrosine kinase activity that activates the cell cycle. The prognosis for CML is better if the Philadelphia chromosome is present. Often, a second chromosomal abnormality occurs in CML before blast crisis.

Keohane, E. M., Preston, M. M., Mirza, K. M., & Walenga, J. M. (2024). Rodak’s Hematology - E-Book: Rodak’s Hematology - E-Book. Elsevier Health Sciences.

Multiple Choice

A 28-y/o male donor presents for whole blood donation. His vitals are normal. He discloses taking Finasteride (for hair loss) 3 days ago. What is the appropriate next step?

• Accept the donor without restrictions

• Temporarily defer for 1 month

• Permanently defer due to hormonal therapy

• Accept only plasma donation

Multiple Choice

A 70-y/o patient with anemia requires a transfusion. The antibody screen is negative. However, post-transfusion hemoglobin falls, and DAT becomes positives (IgG+). Elution reveals anti-Jka. What explains the initially negative antibody screening?

• Kidd antibody was destroyed by enzymes

• Kidd antibody was absorbed onto transfused RBCs

• Kidd antibodies fell below detection but caused DHTR

• The patient has no prior exposure