Anatomy of Hematologic System

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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?

  • A. Frozen RBCs
  • B. Volume-reduced blood products
  • C. Irradiation of all blood products
  • D. Leukoreduced blood products
Correct Answer: D

Rationale: The correct answer is D, Leukoreduced blood products. Leukoreduction removes white blood cells from the blood product, reducing the risk of alloimmunization due to anti-HLA antibodies. White blood cells are a major source of HLA antigens that can stimulate the immune system to produce antibodies. This process helps prevent the development of alloimmunization, which is crucial for patients undergoing stem cell transplant.

A: Frozen RBCs - Freezing does not affect the risk of alloimmunization.
B: Volume-reduced blood products - Volume reduction does not specifically target white blood cells or HLA antigens.
C: Irradiation of all blood products - Irradiation is used to prevent graft-versus-host disease, not specifically to prevent alloimmunization.

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The nurse is reviewing the results of a patient's arterial blood gas analysis. What should the nurse recognize as being a normal blood pH?

  • A. 7.29
  • B. 7.31
  • C. 7.38
  • D. 7.48
Correct Answer: C

Rationale: The normal blood pH range is 7.35-7.45. Choice C (7.38) falls within this range, indicating a normal pH level. Choices A (7.29) and D (7.48) are outside the normal range, indicating acidosis and alkalosis, respectively. Choice B (7.31) is slightly below the normal range, indicating mild acidosis. Therefore, the correct answer is C as it represents a normal blood pH level within the appropriate range.

A 12-year-old patient has been referred to you following complete resection with clean margins of a high-grade malignant peripheral nerve sheath tumor of the shoulder region. The tumor measured approximately 4 cm in greatest dimension. A CT scan of the chest and a bone scan were within normal limits. The patient does not have evidence of neurofibromatosis type 1 (NF1). Which of the following treatment approaches would you recommend?

  • A. Chemotherapy with doxorubicin and ifosfamide
  • B. Radiotherapy
  • C. Chemotherapy with doxorubicin and ifosfamide plus radiotherapy
  • D. Observation
Correct Answer: D

Rationale: The correct answer is D: Observation. In this case, the patient has undergone complete resection of the tumor with clean margins and there is no evidence of metastasis or neurofibromatosis type 1. Given these factors, observation is the most appropriate approach as there is no indication for adjuvant chemotherapy or radiotherapy. Chemotherapy with doxorubicin and ifosfamide (Choice A) is typically reserved for cases with high-risk features such as incomplete resection or metastasis. Radiotherapy (Choice B) may be considered in certain cases, but in this scenario where surgery was curative and there is no evidence of spread, it is not necessary. Chemotherapy plus radiotherapy (Choice C) may be overly aggressive and carry unnecessary risks for a patient who has already had successful surgery. Thus, observation is the most appropriate approach in this situation.

A nurse is reviewing the medication record of a client who is receiving alteplase following an acute myocardial infarction (MI). Which of the following medications should the nurse expect the client to be taking in addition to the alteplase?

  • A. Protamine
  • B. Desmopressin
  • C. Ferrous sulfate
  • D. Heparin
Correct Answer: D

Rationale: The correct answer is D: Heparin. Alteplase is a thrombolytic medication used to dissolve blood clots in acute MI. Heparin is often given concurrently to prevent new clot formation while alteplase works on existing clots. Protamine (A) is used to reverse the effects of heparin, not typically given with alteplase. Desmopressin (B) is used for certain bleeding disorders, not routinely given with alteplase. Ferrous sulfate (C) is an iron supplement, not indicated for MI treatment.

Increase Fe & normal TIBC are found in:

  • A. thalassemia major
  • B. haemosidrosis
  • C. rheumatoid arthritis
  • D. dissiminated malignancy
Correct Answer: C

Rationale: The correct answer is C: rheumatoid arthritis. In rheumatoid arthritis, there is chronic inflammation leading to elevated levels of ferritin (Fe) due to increased iron storage and a normal total iron-binding capacity (TIBC). This is because despite the increased iron stores, the body is unable to utilize it fully due to chronic inflammation.

Incorrect choices:
A: Thalassemia major would typically present with decreased TIBC due to increased iron absorption to compensate for the chronic anemia.
B: Haemosiderosis would show elevated Fe but a decreased TIBC due to iron overload.
D: Disseminated malignancy may show elevated Fe levels but typically with a decreased TIBC due to anemia of chronic disease.

A 35-year-old male is admitted to the hospital complaining of severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this patient suspects a diagnosis of what?

  • A. AML
  • B. CML
  • C. MDS
  • D. ALL
Correct Answer: D

Rationale: The correct answer is D: ALL (Acute Lymphoblastic Leukemia). In this case, the patient's symptoms of severe headaches, vomiting, testicular pain, reduced blood cell counts, and high proportion of immature cells indicate a rapidly progressing hematologic malignancy affecting lymphoid cells. AML (Choice A) primarily affects myeloid cells, not lymphoid cells. CML (Choice B) is a chronic myeloid disorder and presents differently with elevated leukocyte count and mature cells. MDS (Choice C) is a group of disorders characterized by abnormal blood cell production, but the presentation in this patient is more indicative of an acute leukemia.

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