Nokea
Graft versus host disease is a complication of transfusion in patients of bone marrow transplantation. This can be best avoided by
- A. Transfusion of packed cells
- B. Irradiating the blood components before transfusion
- C. Transfusing fresh whole blood
- D. Replacement by crystalloids
Correct Answer: B
Rationale: The correct answer is B: Irradiating the blood components before transfusion. Graft versus host disease occurs when donor T-cells attack the recipient's tissues in bone marrow transplant patients. Irradiating blood components helps to deactivate T-cells in the donor blood, preventing them from attacking the recipient's tissues. Transfusion of packed cells (A) or fresh whole blood (C) does not address the issue of T-cell activation. Replacement by crystalloids (D) is not a solution for preventing graft versus host disease.
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Koilonychias is a specific feature of
- A. Hemolytic anemia
- B. Sickle cell disease
- C. Thalassemia major
- D. Iron deficiency anemia
Correct Answer: D
Rationale: Step-by-step rationale for why D is correct:
1. Koilonychias is characterized by spoon-shaped nails, a common symptom of iron deficiency anemia due to decreased hemoglobin levels.
2. Iron is essential for normal nail growth, and its deficiency can lead to changes in nail shape.
3. Hemolytic anemia (A) is characterized by the premature destruction of red blood cells, not typically associated with koilonychias.
4. Sickle cell disease (B) causes abnormal hemoglobin, leading to sickle-shaped red blood cells, not related to koilonychias.
5. Thalassemia major (C) is a genetic disorder affecting hemoglobin production, but it does not directly cause koilonychias.
A 13-year-old boy presents to the emergency department with complaints of headache and visual changes. History reveals progressive dyspnea on exertion, generalized fatigue, and increased bruising. His labs are significant for a WBC of 350,000/mcL, of which 80% are reported to be blasts and appear to be myeloblasts without the presence of Auer rods. His hemoglobin is 7.2 g/dL, and his platelets are 18,000/mcL. A CT scan of the head shows a small intracerebral hemorrhage. His coags are normal. Which of the following is the most appropriate therapy?
- A. Start induction chemotherapy.
- B. Perform emergent leukapheresis followed the next day by induction chemotherapy.
- C. Perform emergent leukapheresis plus hydroxyurea.
- D. Provide emergent cranial radiation plus hydroxyurea followed the next day by induction chemotherapy.
Correct Answer: C
Rationale: The most appropriate therapy in this scenario is emergent leukapheresis plus hydroxyurea (Choice C). Leukapheresis is needed to rapidly reduce the high white blood cell count, preventing further complications such as leukostasis and hyperviscosity syndrome. Hydroxyurea can help further control the rapid proliferation of blasts. Induction chemotherapy (Choice A) may lead to tumor lysis syndrome due to the high tumor burden. Performing leukapheresis alone without a subsequent therapy (Choice B) may not adequately address the underlying disease. Providing cranial radiation (Choice D) is not the initial management for acute myeloid leukemia.
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 scenario, the patient presents with symptoms of headaches, vomiting, testicular pain, and abnormal blood work showing reduced platelets, leukocytes, and erythrocytes with a high proportion of immature cells. These findings are characteristic of ALL, a type of leukemia that primarily affects lymphoid cells. The combination of symptoms and blood work results suggests a rapid and aggressive proliferation of immature lymphoid cells, leading to bone marrow failure and symptoms such as anemia, thrombocytopenia, and leukopenia. AML (choice A) primarily affects myeloid cells, not lymphoid cells. CML (choice B) typically presents with elevated leukocyte count and presence of the Philadelphia chromosome. MDS (choice C) is a group of disorders characterized by ineffective hematopoiesis leading to cytopenias, but does not typically present with the rapid onset of symptoms seen in this case
Plummer Vinson syndrome is not associated with:
- A. angular stomatitis
- B. splenomegaly
- C. clubbing
- D. post cricoid web
Correct Answer: C
Rationale: The correct answer is C: clubbing. Plummer Vinson syndrome is characterized by the triad of dysphagia, iron deficiency anemia, and esophageal webs. Clubbing is not a typical feature of this syndrome. Angular stomatitis (A), splenomegaly (B), and post cricoid web (D) are all associated with Plummer Vinson syndrome. Angular stomatitis is due to iron deficiency anemia, splenomegaly can be present due to chronic anemia, and post cricoid web is a characteristic finding in the esophagus of patients with this syndrome.
The nurse is assessing a client experiencing anemia. Which laboratory findings will the nurse expect for this client? (Select all that apply.)
- A. Increased hematocrit
- B. Decreased red blood cell count
- C. Decreased serum iron
- D. Decreased hemoglobin
Correct Answer: b
Rationale: The correct answer is B: Decreased red blood cell count. Anemia is characterized by a decrease in the number of red blood cells, leading to a lower than normal red blood cell count. In anemia, the body cannot transport enough oxygen to tissues, leading to symptoms such as fatigue and shortness of breath. Increased hematocrit (A) and decreased hemoglobin (D) are related to anemia but not specific enough to be conclusive. Decreased serum iron (C) may be seen in iron-deficiency anemia but is not always present in all types of anemia.