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TitleHematology
TagsLymphocyte Granulocyte White Blood Cell Haematopoiesis Bone Marrow
File Size14.1 MB
Total Pages144
Document Text Contents
Page 73

REVIEW QUESTIONS • 301

119. Which of the following is an acquired red
cell membrane defect that results in
increased sensitivity to complement
binding?
A. March hemoglobinuria
B. Paroxysmal nocturnal hemoglobinuria
C. Paroxysmal cold hemoglobinuria
D. Methemoglobinemia

120. Which of the following is not associated
with acquired reversible sideroblastic
anemias?
A. Methotrexate therapy
B. Lead intoxication
C. Isoniazid treatment for tuberculosis
D. Acute alcohol ingestion

121. Which of the following statements about
the relative anemia of pregnancy is false?
A. It is due to a reduction in the number

of erythrocytes.
B. It is normocytic and normochromic.
C. It does not produce an oxygen deficit

for the fetus.
D. It is associated with an increase in

plasma volume.

122. The anemia found in chronic renal failure
is most likely caused by
A. Loss of erythropoietin synthesis
B. Lack of cellular oxygen demand
C. Defective iron absorption
D. Destruction of red cells by uremic

metabolites

123. Which of the following phrases about
aplastic anemia is false?
A. Stem cell disorder
B. Risk of life-threatening infection
C. Frequent bleeding complications
D. Reduced red cell survival

124. The fish tapeworm Diphyllobothrium latum
is associated with the development of
A. Microcytic anemia
B. Macrocytic anemia
C. Hemolytic anemia
D. Hypoproliferative anemia

125. An increase in erythropoietin is not
a normal compensating mechanism in
which of the following conditions?
A. Renal tumors
B. Heavy smoking
C. Cardiovascular disease
D. Pulmonary disease

126. Thalassemias are the result of a
A. Structural defect in the heme portion

of hemoglobin
B. Quantitative defect in globin-chain

synthesis
C. Qualitative defect in globin-chain

structure
D. Change in hemoglobin solubility

properties

127. Which of the following characterizes iron-
deficiency anemia?
A. Decreased serum iron, decreased

transferrin saturation, normal ferritin
B. Decreased serum transferrin,

decreased transferrin saturation,
decreased ferritin

C. Increased serum transferrin, decreased
transferrin saturation, decreased ferritin

D. Increased serum transferrin, increased
transferrin saturation, decreased serum
iron

128. Clinical manifestations of a homozygous
mutation involving the beta-globin gene
will most likely appear
A. During embryonic development
B. In the neonate at birth
C. No later than 3 weeks after birth
D. By 6 months of age

Page 143

ANSWERS & RATIONALES • 371

294. 297. 1
D. In most cases of MDS, the bone marrow is
hypercellular with erythroid hyperplasia. MDS
is considered a disease of the elderly. Because
normal cellularity decreases with age, interpre-
tation of cellularity must take the age of the
patient into account. WHO criteria for a diagno-
sis of MDS are related to bone marrow blast per-
cent, which must be <20%.

295.
D. In RAEB at least two cell lines exhibit
cytopenia, and all cell lines show evidence of
dyshematopoiesis. Poor granulation and pseudo-
Pelger-Huet anomaly is seen. There are less than
5% blasts in the peripheral blood, and between
5 and 19% blasts in the bone marrow. Platelets
exhibit poor granulation, giant forms, and the
abnormal maturation stage of micromegakary-
ocytes. The five FAB classifications of
myelodysplastic syndrome are RA, RARS,
RAEB, CMML, and RAEB-t. CML is a myelo-
proliferative disorder, not a myelodysplastic
syndrome.

296.
C. The myelodysplastic syndromes are refrac-
tory to treatment, and patients are supported
using blood products dependant on their cytope-
nias. The median survival rate for all types of
MDSs is less than 2 years. RAEB and RAEB-t
have the highest percentage of blasts and the
lowest survival rates. At this time, bone marrow
transplant offers the only chance for a cure, and
it is the treatment of choice in patients less than
50 years old. Studies have shown that the inci-
dence of MDS is greater than the incidence of
AML in the 50-70-year-old age group. Up to
40% of the myelodysplastic syndromes trans-
form into acute leukemia.

B. Chronic myelogenous leukemia (CML) is a
myeloproliferative disorder, a malignant prolif-
eration of leukocytes not in response to infec-
tion; the leukocyte count is often greater than
100.0 X 109/L. No toxic changes are present in
CML. Thrombocytosis is seen in more than half
of the patients with CML. A neutrophilic leuke-
moid reaction represents a normal body
response to a severe infection. It is a benign pro-
liferation of WBCs with a high leukocyte count
but usually less than 50.0 X 109/L. Toxic
changes to the neutrophils such as toxic granula-
tion, vacuoles, and Dohle bodies are present.
These two disorders both display a "left" shift,
and they can be confused with each other.

298.
D. Leukocyte alkaline phosphatase activity is
increased in severe infections such as the neu-
trophilic leukemoid reaction and polycythemia
vera, and during the last trimester of pregnancy.
It is greatly reduced in chronic myelogenous
leukemia, although it may increase during blast
crisis of this disease. Periodic acid-Schiff and
Sudan black B are used to differentiate ALL
from AML. The TRAP stain is useful in the
diagnosis of hairy cell leukemia.

299.
C. The Philadelphia chromosome, t(9;22), is
found in the precursor cells for erythrocytes,
granulocytes, and platelets in at least 90% of the
cases of CML. It is an acquired chromosome
abnormality that results from a reciprocal
translocation between chromosomes 9 and 22,
and it can be detected even when the patient is in
remission. The BCR/ABL oncogene is also
associated with CML.

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