ATI Hematologic System

ATI Hematologic System Related

Review ATI Hematologic System related questions and content

A 4-year-old girl with a history of relapsed pre-B-cell acute lymphoblastic leukemia is being admitted for unrelated donor bone marrow transplantation with cyclophosphamide and total body irradiation conditioning. Pretransplant workup shows the following: Recipient: CMV IgG: negative, CMV IgM: negative, HSV I/II antibody: negative, Varicella IgG: positive (vaccinated), Hepatitis B surface antigen: negative, Hepatitis B surface antibody: positive (vaccinated), Hepatitis B core antibody: negative, Hepatitis C antibody: negative. Donor: CMV IgG: negative, CMV IgM: negative, HSV I/II antibody: positive, Varicella IgG: positive, Hepatitis B surface antigen: negative, Hepatitis B core antibody: negative, Hepatitis C antibody: negative. How should the patient be managed during the admission with respect to infection prophylaxis?

  • A. Acyclovir IV for herpes simplex virus (HSV) suppression
  • B. Weekly screening by polymerase chain reaction (PCR) for cytomegalovirus (CMV) in blood
  • C. Antifungal prophylaxis
  • D. Valganciclovir PO for CMV suppression
Correct Answer: C

Rationale: The correct answer is C: Antifungal prophylaxis. This patient is at high risk for fungal infections post-bone marrow transplantation due to the conditioning regimen with cyclophosphamide and total body irradiation. CMV and HSV prophylaxis are not indicated as the patient and donor are negative for CMV IgG and IgM and the donor is positive for HSV antibodies. Weekly CMV PCR screening is not necessary in the absence of CMV seropositivity. Valganciclovir for CMV suppression is also not required in this case. Fungal prophylaxis is essential to prevent invasive fungal infections in high-risk patients like this 4-year-old with leukemia.

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In the laboratory diagnosis of leishmaniasis, the expected parasite stage in vitro is

  • A. Amastigote
  • B. Promastigote
  • C. Trypomastigote
  • D. Schizont
Correct Answer: B

Rationale: The correct answer is B: Promastigote. In the laboratory diagnosis of leishmaniasis, the parasite stage typically observed in vitro is the promastigote stage. This is because promastigotes are the infective form of the parasite found in the sandfly vector. When a sample is taken from a patient, it is cultured in a suitable medium where promastigotes develop. Amastigotes (choice A) are the intracellular form found in the host, not typically observed in vitro. Trypomastigotes (choice C) are the stage found in Trypanosoma species, not Leishmania. Schizonts (choice D) are a stage in the life cycle of Plasmodium species causing malaria, not Leishmania. Promastigotes are the stage most commonly used for laboratory diagnosis and research in leishmaniasis.

A nurse is caring for four clients. After reviewing today's laboratory results, which client would the nurse assess first?

  • A. Client with an international normalized ratio of 2.8
  • B. Client with a platelet count of 128,000/mm3 (128 x 109/L).
  • C. Client with a prothrombin time (PT) of 28 seconds
  • D. Client with a red blood cell count of 5.1 million/mcl. (5.1 x 1012/L)
Correct Answer: C

Rationale: The correct answer is C: Client with a prothrombin time (PT) of 28 seconds. A PT measures the time it takes for blood to clot, indicating the client's clotting ability. A PT of 28 seconds is prolonged, suggesting a potential bleeding risk. This client should be assessed first to prevent any complications related to inadequate clotting.

A: Client with an international normalized ratio of 2.8 - Although an elevated INR indicates a risk of bleeding, it is not as time-sensitive as a prolonged PT.
B: Client with a platelet count of 128,000/mm3 - While low platelets can lead to bleeding, a prolonged PT is more critical for immediate assessment.
D: Client with a red blood cell count of 5.1 million/mcl - This value is within normal range and does not indicate an urgent issue related to clotting.

Non thrombocytopenic purpura is seen in all except:

  • A. vasculitis
  • B. uraemia
  • C. hereditary haemorrhagic telangiectasia
  • D. SLE
Correct Answer: D

Rationale: The correct answer is D: SLE. Non-thrombocytopenic purpura refers to purpura without low platelet count. In SLE, thrombocytopenia is common, leading to purpura. A: Vasculitis can cause non-thrombocytopenic purpura due to vessel inflammation. B: Uraemia can lead to non-thrombocytopenic purpura due to vascular damage. C: Hereditary haemorrhagic telangiectasia presents with telangiectasias and recurrent epistaxis, not purpura.

Which of the following is a cause of secondary neutropaenia in adults?

  • A. Congenital
  • B. Anti-hypertensive drugs
  • C. Part of general pancytopaenia
  • D. Familial
Correct Answer: C

Rationale: Rationale: Secondary neutropenia in adults is often a part of general pancytopenia, which involves a decrease in all three blood cell types. This can be caused by factors such as bone marrow suppression from chemotherapy, radiation therapy, or certain medications. Neutropenia is not typically congenital or familial in adults, and anti-hypertensive drugs are not commonly known to directly cause secondary neutropenia. Therefore, the correct answer is C as it aligns with the common etiology of secondary neutropenia in adults.

Blinatumomab, a bispecific T-cell engaging molecule, is active against which CD antigen that is expressed on B-lymphoblasts?

  • A. CD10
  • B. CD15
  • C. CD19
  • D. CD20
Correct Answer: C

Rationale: Rationale:
1. Blinatumomab is designed to engage T cells to target CD19 antigen on B-lymphoblasts.
2. CD19 is a specific marker expressed on B cells, making it a target for Blinatumomab.
3. CD10 is not targeted by Blinatumomab and is commonly found on early B-cell precursors.
4. CD15 and CD20 are not targeted by Blinatumomab and have different functions unrelated to B-lymphoblasts.

Summary:
- CD19 is the correct answer as it is the specific target for Blinatumomab on B-lymphoblasts.
- CD10, CD15, and CD20 are incorrect as they are not the targeted antigens for Blinatumomab and have different roles in immune function.

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