ATI Hematologic System

ATI Hematologic System Related

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You have a new 7-year-old female patient with a WBC count of 6,000/mm3, hemoglobin of 7.2 g/dL, and platelet count of 30,000/mm3. A bone marrow aspirate reveals 14% blasts with a monocytic morphologic appearance that are surface marker positive for CD33. You receive a call from the fluorescence in situ hybridization (FISH) lab that the bone marrow is positive for KMT2A rearrangement in 68% of cells. Your staff asks whether this represents a diagnosis of acute leukemia in the current classification scheme for this type of hematologic malignancy. What would you say?

  • A. No, because for a diagnosis of acute leukemia you must have 30% or more blasts in the marrow.
  • B. No, because for a diagnosis of acute leukemia you must have 20% or more blasts in the marrow.
  • C. No, because the cytogenetics do not include +21, monosomy 7, or trisomy 8.
  • D. Yes, because the FISH is positive for KMT2A rearrangement.
Correct Answer: D

Rationale: The correct answer is D: Yes, because the FISH is positive for KMT2A rearrangement.

Rationale:
1. KMT2A rearrangement is a genetic abnormality commonly associated with acute leukemia.
2. Presence of blasts (14%) with monocytic appearance and positive for CD33 also supports the diagnosis.
3. The percentage of blasts (14%) is not below the threshold for acute leukemia diagnosis.
4. The specific cytogenetic findings mentioned in choice C are not absolute requirements for diagnosing acute leukemia.

In summary, the presence of KMT2A rearrangement, along with morphologic and flow cytometry findings, supports the diagnosis of acute leukemia in this case, making choice D the correct answer.

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The following pathological features is true regarding non-Hodgkin lymphoma (NHL)

  • A. Classical Reed-Sternberg (RS) cells are neoplastic cells
  • B. B cell phenotype is more common
  • C. Contiguous group of lymph nodes are affected
  • D. It is not associated with leukemic phase of disease
Correct Answer: B

Rationale: Step 1: Non-Hodgkin lymphoma (NHL) can arise from either B cells or T cells. B cell NHL is more common than T cell NHL.
Step 2: The B cell phenotype is predominant in NHL, making choice B correct.
Step 3: Classical Reed-Sternberg cells are characteristic of Hodgkin lymphoma, not NHL, making choice A incorrect.
Step 4: NHL can involve non-contiguous lymph nodes, ruling out choice C.
Step 5: NHL can present with leukemic involvement, refuting choice D.
Overall, the B cell phenotype being more common in NHL makes choice B the correct answer.

Assuming that adherence has been excellent, which of the following should have returned to normal 6 weeks following appropriate oral iron treatment for a child with severe dietary iron deficiency (hemoglobin [Hgb] 5.0 g/dL and mean corpuscular volume [MCV] 48 fL at the beginning of therapy)?

  • A. Hgb concentration
  • B. MCV
  • C. Red cell distribution width
  • D. Peripheral blood smear
Correct Answer: A

Rationale: Rationale:
1. Hemoglobin (Hgb) reflects the oxygen-carrying capacity of red blood cells.
2. Severe dietary iron deficiency causes low Hgb levels.
3. Adequate iron treatment should lead to increased Hgb levels.
4. MCV and other parameters may take longer to normalize.
Summary:
B, C, and D are incorrect because MCV and red cell distribution width may take longer to normalize, and peripheral blood smear changes may persist even after Hgb has returned to normal.

A study is designed to investigate the rates of central line–associated blood stream infections among pediatric hematology/oncology patients. Three common central line types (totally implanted catheter [port], peripherally inserted central catheter [PICC], and tunneled externalized catheter [TEC]) were included in the study. What data structure is central line type?

  • A. Continuous
  • B. Dichotomous
  • C. Nominal
  • D. Ordinal
Correct Answer: C

Rationale: The correct answer is C: Nominal. The central line types in this study (port, PICC, TEC) are categorical and do not have a natural order or ranking. They are simply names or labels representing different types of central lines. This makes them fall under the nominal data structure category. Continuous data (choice A) would involve measurements with infinite possible values. Dichotomous data (choice B) would have only two categories. Ordinal data (choice D) would imply a natural ranking or order among the categories, which is not applicable in this context.

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.

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.

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