Anatomy of Hematologic System

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A 13-year-old girl presents with acute myeloid leukemia (AML) and a WBC count of 120,000/mm3. Cytogenetics reveals a normal karyotype, and fluorescence in situ hybridization (FISH) tests for inv(16), t(8;21), t(15;17); 11q23 abnormalities; monosomy 7; and 5q deletion are negative. Molecular testing is negative for mutations in FLT3, NPM1, and CEBPA. She is treated with 10 days of daunorubicin, AraC, and gemtuzumab for induction therapy. On day 30, she recovers counts, and a bone marrow aspiration shows 2.2% leukemic blasts by flow cytometry. She receives a second course of treatment with daunorubicin and AraC, and her marrow is now in morphologic remission and is MRD-negative by flow cytometry. She has no HLA-matched siblings, but an unrelated donor search reveals a large number of potential matches. Which course of treatment is most likely to result in the best outcome?

  • A. Give two more courses of intensification chemotherapy.
  • B. Perform an autologous hematopoietic stem cell transplant (HSCT).
  • C. Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
  • D. Give one more course of intensification chemotherapy and then 1 year of maintenance chemotherapy.
Correct Answer: C

Rationale: The correct answer is C: Give one more course of intensification chemotherapy and then perform a matched unrelated donor HSCT.
Rationale:
1. The patient achieved morphologic remission and MRD-negative status after the second course of chemotherapy, indicating good response.
2. Given the high-risk AML with negative cytogenetics and molecular markers, HSCT from a matched unrelated donor offers the best chance for long-term remission.
3. HSCT provides a curative option by replacing the patient's diseased bone marrow with healthy donor cells, reducing the risk of relapse.
4. The presence of a large number of potential matched unrelated donors increases the likelihood of finding a suitable donor for the transplant.

Summary:
- Option A: Giving more courses of intensification chemotherapy may not address the high-risk nature of the disease and may not provide a curative outcome.
- Option B: Autologous HSCT uses the patient's own stem cells, which may carry the risk of relapse due

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The nurse is reviewing the parts of the complete blood count and differential with a patient. Where should the nurse state that neutrophils, eosinophils, and basophils are produced?

  • A. Spleen
  • B. Thymus
  • C. Lymph nodes
  • D. Red bone marrow
Correct Answer: D

Rationale: The correct answer is D: Red bone marrow. Neutrophils, eosinophils, and basophils are all types of white blood cells that are produced in the red bone marrow through a process called hematopoiesis. The red bone marrow is a primary site for the production of blood cells, including these specific types of white blood cells. Neutrophils are important for fighting bacterial infections, eosinophils are involved in allergic reactions and parasitic infections, and basophils play a role in allergic responses. Therefore, it is crucial for the nurse to inform the patient that these cells are produced in the red bone marrow. The other choices (A: Spleen, B: Thymus, C: Lymph nodes) are incorrect as these organs do not play a primary role in the production of these specific types of white blood cells.

The mean cell volume of the patient is 90 fl and the reticulocyte production index is low. Which of the following is the most possible cause of anemia in this patient?

  • A. Thalassemia
  • B. Vitamin B12 deficiency
  • C. Aplastic anemia
  • D. Sideroblastic anemia
Correct Answer: C

Rationale: The correct answer is C: Aplastic anemia. Aplastic anemia is characterized by a low reticulocyte production index due to bone marrow failure, leading to decreased red blood cell production and subsequently causing anemia. Thalassemia (choice A) is a genetic disorder resulting in abnormal hemoglobin production, not bone marrow failure. Vitamin B12 deficiency (choice B) can lead to macrocytic anemia, not a low reticulocyte production index. Sideroblastic anemia (choice D) is characterized by abnormal iron metabolism in the bone marrow, not bone marrow failure.

A 2-year-old girl has a diagnosis of overall stage IV favorable histology Wilms' tumor with pulmonary metastases and local stage III disease due to finding positive lymph nodes. After she completes 6 weeks of vincristine/dactinomycin/doxorubicin (DD4A) chemotherapy, restaging shows complete resolution of some but not all lung nodules. Tumor genetic testing reveals combined loss of heterozygosity for 1p and 16q. Which of the following would be the most appropriate treatment plan?

  • A. Continue chemotherapy with vincristine, doxorubicin, and dactinomycin to complete 25 weeks of therapy. Administer radiation to lungs and flank.
  • B. Continue chemotherapy with vincristine, doxorubicin and dactinomycin to complete 25 weeks of therapy. Radiation to flank only. No lung radiation.
  • C. Continue chemotherapy with vincristine, doxorubicin and dactinomycin, add cyclophosphamide and etoposide to complete 33 weeks of therapy. Radiation to flank only. No lung radiation.
  • D. Continue chemotherapy with vincristine, doxorubicin and dactinomycin, add cyclophosphamide and etoposide to complete 33 weeks of therapy. Radiation to lungs and flank.
Correct Answer: D

Rationale: The correct answer is D because the addition of cyclophosphamide and etoposide to the chemotherapy regimen is indicated for patients with combined loss of heterozygosity for 1p and 16q in Wilms' tumor. This genetic abnormality is associated with a higher risk of relapse and poorer outcomes. The extended duration of chemotherapy (33 weeks) is necessary to target any remaining tumor cells and reduce the risk of recurrence. Additionally, the decision to administer radiation to both the lungs and flank is appropriate given the incomplete resolution of some lung nodules after initial chemotherapy. Lung radiation helps to target any remaining metastatic lesions, while flank radiation targets the primary tumor site and positive lymph nodes. This comprehensive treatment approach aims to maximize the chances of long-term disease control and survival for the patient.

Choice A is incorrect because it lacks the addition of cyclophosphamide and etoposide, which are needed for Wilms' tumor with the specific genetic abnormality mentioned.

Cooley's anemia is:

  • A. Sickle cell an.
  • B. thalassemia major
  • C. high ESR
  • D. aplastic an.
Correct Answer: B

Rationale: Cooley's anemia is another term for thalassemia major, a genetic disorder characterized by abnormal hemoglobin production leading to severe anemia. The correct answer is B because Cooley's anemia specifically refers to thalassemia major. Sickle cell anemia (A) is a different genetic disorder caused by abnormal hemoglobin shape. High ESR (C) is a nonspecific marker of inflammation and does not directly relate to Cooley's anemia. Aplastic anemia (D) is a condition where the bone marrow does not produce enough blood cells, not related to Cooley's anemia.

A nurse is caring for a client who is experiencing an acute ischemic cerebrovascular event due to a thrombus in a cerebral vessel. Which of the following drugs should the nurse expect to administer?

  • A. Alteplase
  • B. Aspirin
  • C. Clopidogrel
  • D. Heparin
Correct Answer: A

Rationale: The correct answer is A: Alteplase. Alteplase is a thrombolytic agent used to dissolve blood clots and restore blood flow in acute ischemic stroke. It is crucial to administer within a specific time frame for the best outcome. Aspirin (B) and Clopidogrel (C) are antiplatelet agents that prevent further clot formation but are not used for immediate clot dissolution in acute ischemic stroke. Heparin (D) is an anticoagulant that prevents clot formation and is not typically used as the initial treatment for acute ischemic stroke.

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