ATI Hematologic System Test

ATI Hematologic System Test Related

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A 13-year-old Hispanic girl is found to have a WBC count of 6,500/mm3 with 40% Auer rod–containing granular blasts that, by flow cytometry, express very bright CD33 but are negative for human leukocyte antigen–DR isotype (HLA-DR). She is oozing blood around her peripheral IV site. Coagulation studies reveal an international normalized ratio (INR) of 3.4, a fibrinogen of 170, and a markedly elevated D-dimer. Marrow aspirate shows nearly 90% blasts with a similar morphology. You send the marrow to the fluorescence in situ hybridization (FISH) lab and request STAT testing for the most likely recurrent genetic abnormality based on the clinical presentation. How do you plan to initiate therapy?

  • A. Perform a lumbar puncture to determine leukemic involvement, then proceed with induction chemotherapy.
  • B. Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.
  • C. Start dexamethasone and hydroxyurea immediately while aggressively managing coagulopathy with blood product support.
  • D. Start induction chemotherapy, obtain HLA typing, and start a donor search because of the poor prognosis associated with this leukemic phenotype.
Correct Answer: B

Rationale: The correct answer is B: Begin therapy with all-trans retinoic acid (ATRA) immediately while aggressively managing coagulopathy with blood product support.

Rationale:
1. The clinical presentation describes acute promyelocytic leukemia (APL), characterized by Auer rod-containing blasts, coagulopathy (elevated INR, D-dimer), and CD33 positivity. ATRA is the standard treatment for APL.
2. ATRA induces differentiation of leukemic promyelocytes, reducing the risk of disseminated intravascular coagulation (DIC) and bleeding.
3. Aggressively managing the coagulopathy with blood product support is crucial to prevent hemorrhagic complications.

Summary:
A: Not needed as the clinical presentation already suggests APL. Lumbar puncture is not indicated for APL diagnosis.
C: Dexamethasone and hydroxyurea are not standard treatments for APL. Immediate ATRA therapy is preferred.
D

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Increase serum iron:-decrease IBC a feature of:

  • A. Hookworm infestation
  • B. sideroblastic an.
  • C. alcoholic liver dis.
  • D. th.major
Correct Answer: B

Rationale: Step-by-step rationale:
1. Sideroblastic anemia results in defective heme synthesis, leading to iron accumulation in the mitochondria.
2. This excess iron saturation decreases the Iron Binding Capacity (IBC) in the serum.
3. Therefore, in sideroblastic anemia, increasing serum iron is associated with a decrease in IBC.
Summary of other choices:
A: Hookworm infestation causes iron deficiency anemia with increased IBC.
C: Alcoholic liver disease can lead to iron overload, not a decrease in IBC.
D: Thalassemia major is associated with increased IBC due to ineffective erythropoiesis.

An oncology nurse recognizes a patient's risk for fluid imbalance while the patient is undergoing treatment for leukemia. What relevant assessments should the nurse include in the patient's plan of care? Select all that apply.

  • A. Monitoring the patient's electrolyte levels
  • B. Monitoring the patient's hepatic function
  • C. Measuring the patient's weight on a daily basis
  • D. Measuring and recording the patient's intake and output
Correct Answer: B

Rationale: The correct answer is B: Monitoring the patient's hepatic function. In leukemia treatment, the patient may undergo chemotherapy which can affect liver function, leading to fluid imbalance. By monitoring hepatic function, the nurse can assess the liver's ability to maintain fluid balance.

A: Monitoring electrolyte levels is important for fluid balance but may not directly assess the liver's role in maintaining balance.
C: Measuring weight daily is crucial for monitoring fluid status but does not directly assess liver function.
D: Measuring and recording intake and output is essential for assessing fluid balance but does not directly evaluate hepatic function.

Dohle bodies are patches of dilated endoplasmic reticulum that appear as cerulean blue cytoplasmic puddles. These findings are mostly seen in

  • A. Chronic myeloid leukemia
  • B. Leukemoid reaction
  • C. Chediak-Higashi syndrome
  • D. Infectious mononucleosis
Correct Answer: D

Rationale: The correct answer is D: Infectious mononucleosis. Dohle bodies are seen in infectious mononucleosis due to the accumulation of rough endoplasmic reticulum in neutrophils. This is a result of the viral infection causing stress on the neutrophils. In chronic myeloid leukemia (A), leukemoid reaction (B), and Chediak-Higashi syndrome (C), Dohle bodies are not typically observed. In chronic myeloid leukemia, the characteristic finding is the Philadelphia chromosome. Leukemoid reaction is a reactive increase in white blood cells due to infection or inflammation. Chediak-Higashi syndrome is a rare autosomal recessive disorder characterized by defective phagolysosome formation.

A nurse is caring for a client who is scheduled for an outpatient surgical procedure and reports taking aspirin 81 mg daily, including this morning. The nurse should identify that this places the client at risk for which of the following complications?

  • A. Uncontrolled bleeding
  • B. Myocardial infarction
  • C. Respiratory depression
  • D. Decreased renal perfusion
Correct Answer: A

Rationale: Rationale: Aspirin is an antiplatelet medication that inhibits platelet aggregation, increasing the risk of uncontrolled bleeding during surgical procedures. By taking aspirin, the client's blood clotting ability is impaired, leading to potential excessive bleeding during and after surgery. This can result in complications such as prolonged bleeding, hematoma formation, and delayed wound healing. Therefore, the correct answer is A: Uncontrolled bleeding.

Summary:
- B: Myocardial infarction is not directly related to taking aspirin; it is actually used to prevent heart attacks.
- C: Respiratory depression is not a common complication associated with aspirin use.
- D: Decreased renal perfusion is not a typical risk of taking aspirin; it primarily affects the cardiovascular system.

Which of the following best characterizes the function of ferroportin in iron metabolism?

  • A. A form of storage iron in intestinal mucosal cells
  • B. A transport protein in the plasma
  • C. A receptor protein on the surface of erythroid progenitors
  • D. Transmembrane iron exporter
Correct Answer: D

Rationale: Ferroportin is a transmembrane iron exporter responsible for releasing iron from cells into the bloodstream. It is crucial in regulating systemic iron levels. Choice A is incorrect as storage iron is typically stored as ferritin. Choice B is incorrect as ferroportin is not found in the plasma but on cell membranes. Choice C is incorrect as erythroid progenitors do not directly interact with ferroportin. Therefore, the correct answer is D as it accurately describes the function of ferroportin in iron metabolism.

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