ATI Hematologic System

ATI Hematologic System Related

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A newborn infant develops jaundice on day of life 2. Labs are drawn, and she has a hemoglobin of 7.4 g/dL with a reticulocyte count of 8%. Upon peripheral blood smear review, she is found to have bizarre red cell forms with significant polkilocytosis. Although her parents have normal blood counts, on review of their peripheral blood smears, they both have a moderate number of ovalocytes. Which of the following is the most likely cause of the infant's red cell findings?

  • A. She has an autosomal dominant ankyrin mutation from one of her parents causing hereditary spherocytosis.
  • B. She has inherited band 3 variants from each parent and will likely need a splenectomy after she turns 5 years old.
  • C. She has inherited an alpha-spectrin mutation from both of her parents and may experience an improvement in her anemia over time.
  • D. She has inherited a PKLR variant from each parent, and enzyme testing will be consistent with her diagnosis of pyruvate kinase deficiency.
Correct Answer: C

Rationale: The correct answer is C because the infant likely has hereditary elliptocytosis, an autosomal dominant disorder caused by mutations in the alpha-spectrin gene. Ovalocytes and polkilocytosis are characteristic of this condition. Since both parents have ovalocytes, it is likely that the infant inherited mutations from each parent, resulting in a more severe presentation. Anemia in hereditary elliptocytosis can improve over time due to compensatory mechanisms. Choices A, B, and D are incorrect as they describe different genetic disorders (hereditary spherocytosis, hereditary stomatocytosis, and pyruvate kinase deficiency, respectively) and do not match the clinical and family history provided.

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Which of the following will be present in chronic bacterial infection?

  • A. Neutrophilia
  • B. Basophilia
  • C. Lymphocytosis
  • D. Monocytosis
Correct Answer: D

Rationale: The correct answer is D: Monocytosis. In chronic bacterial infections, there is a prolonged immune response leading to an increased production of monocytes to help combat the infection. Neutrophilia (choice A) is more characteristic of acute bacterial infections. Basophilia (choice B) is associated with allergic reactions or certain blood disorders, not typically seen in bacterial infections. Lymphocytosis (choice C) is more common in viral infections or certain immune responses, not specific to chronic bacterial infections.

A laboratory finding of aplastic anaemia

  • A. Pancytopaenia
  • B. Erythrocytosis
  • C. Bone marrow hypercellularity
  • D. Reticulocytosis
Correct Answer: A

Rationale: Rationale:
1. Aplastic anemia is characterized by bone marrow failure, leading to decreased production of all blood cell types.
2. Pancytopenia refers to low levels of red blood cells, white blood cells, and platelets, consistent with aplastic anemia.
3. Erythrocytosis is an increase in red blood cell count, contradictory to the reduced production in aplastic anemia.
4. Bone marrow hypercellularity indicates increased cellularity, opposite to the hypocellularity seen in aplastic anemia.
5. Reticulocytosis is an elevated number of immature red blood cells, which is not typically seen in the context of bone marrow failure in aplastic anemia.

Summary:
A is correct as it aligns with the characteristic pancytopenia in aplastic anemia. B, C, and D are incorrect due to their inconsistency with the pathophysiology of the condition.

A nurse is caring for a client who recently started alteplase therapy. The nurse should monitor the client for which of the following adverse effects?

  • A. Bronchodilation
  • B. Headache
  • C. Edema
  • D. Hypertension
Correct Answer: B

Rationale: The correct answer is B: Headache. Alteplase is a thrombolytic medication that can increase the risk of bleeding, including intracranial bleeding, leading to headaches. Monitoring for headaches is crucial to detect any signs of bleeding. Bronchodilation (A) is not a common adverse effect of alteplase. Edema (C) and hypertension (D) are also not typically associated with alteplase therapy. Monitoring for headache is essential for early detection of potentially life-threatening complications.

You are seeing a 2-year-old girl with new onset of fever and bronchitis. She has maculopapular rash and hepatosplenomegaly. Blood smear shows leukocytosis (100,000/mm3), anemia, and thrombocytopenia. Ancillary tests include fetal hemoglobin of 80% and normal blood karyotype. What is the most likely diagnosis?

  • A. Leukemoid Reaction
  • B. Acute lymphoblastic leukemia (ALL)
  • C. Chronic myeloid leukemia (CML)
  • D. Juvenile myelomonocytic leukemia (JMML)
Correct Answer: D

Rationale: The most likely diagnosis in this case is Juvenile myelomonocytic leukemia (JMML). JMML is a rare myelodysplastic/myeloproliferative neoplasm seen in young children. The clinical presentation of fever, rash, hepatosplenomegaly, leukocytosis, anemia, and thrombocytopenia is consistent with JMML. The presence of fetal hemoglobin of 80% is a key finding in JMML, as it is a distinguishing feature. Additionally, a normal blood karyotype rules out chromosomal abnormalities commonly seen in other leukemias. Leukemoid reaction (Choice A) is characterized by a reactive increase in leukocyte count due to an underlying condition, but it does not explain the other findings in this case. Acute lymphoblastic leukemia (ALL - Choice B) primarily affects lymphoid cells, not myeloid cells as seen in this case. Chronic myeloid leukemia (C

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.

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