Hematology 3

A 45-year-old woman is diagnosed with pernicious anemia. Which of the following laboratory results is most likely to be noted?

A 79-year-old man has a 3-week history of fever, night sweats and fatigue. Examination shows diffuse lymphadenopathy involving the axillary, cervical and inguinal chains. No petechiae are noted. Results of the CBC show a white blood count of 112,000/microL. Which of the following is the most likely diagnosis?

Ten days after a 24-year-old soldier was given primaquine for malaria prophylaxis, he presents with jaundice. Which of the following laboratories is most consistent with his presentation?

A 17-year-old female patient presents for a follow-up after recurrent epistaxis and persistent and prolonged gingival bleeding after dental procedures. Laboratory evaluation finds platelet number and morphology to be normal however bleeding time is increased. Further testing shows that factor VIII levels are reduced. Which of the following is the most likely diagnosis?

A 44-year-old male presents with fatigue, night sweats and low-grade fever for the last month. On physical examination the patient is found to have splenomegaly. Lab results show the patient with a total white blood cell count of 150,000/microL with significant neutrophilia. The laboratory also reports the presence of a Philadelphia chromosome. Which of the following is the most likely diagnosis?

Which of the following laboratory findings differentiates anemia due to iron deficiency from anemia due to thalassemia?

A 12-year-old patient with sickle cell history is admitted to the hospital severe, diffuse abdominal pain. The patient is acutely febrile with a temperature of 103.4°F. Physical exam finds the patient with diffuse abdominal pain and rebound tenderness. Bowel sounds are hypoactive. Laboratory evaluation finds the patient with a leukocytosis of 22,000/microL. Which of the following is the most likely diagnosis?

Which of the following is the most common presentation of sickle cell anemia in an infant?

A 19-year-old male presents the office with a painless lump on the right side of his neck which he has noted for the last month and a half. The patient has had some mild fever and night sweats over the last few weeks. Evaluation of his chest x-ray finds a mediastinal mass. Presence of which of the following would be considered the hallmark for this disease process?

A 76-year-old woman who is on chronic hemodialysis has hemoglobin of 8 g/dL. Evaluation shows a normochromic normocytic anemia. Serum ferritin level is 300 mg/mL. Which of the following is the preferred therapy for the anemia?

A 24-year-old male patient presents with a DVT in his left lower extremity. He has not had prior episodes of bleeding or clotting symptoms. Initial laboratory tests are ordered, and the results are as follows:
Bleeding time: 4.5 minutes (normal)
PT/INR: 12.0 sec/1.0 (normal)
PTT: 28 sec (normal)
Based on this information, the differential diagnosis for this patient includes all of the following conditions except:

A 68-year-old female patient is incidentally noted to have an elevated HCT of 58%. Which of the following additional laboratory results would suggest a diagnosis of secondary erythrocytosis?

According to the modified Rai classification for chronic lymphocytic leukemia (CLL), a patient who presents with peripheral blood lymphocytosis and lymphadenopathy, with no associated splenomegaly, hepatomegaly, anemia, or thrombocytopenia, would be clinically at what stage of the disease?

A 30-year-old male patient presents complaining of abdominal pain and dark urine. On examination, jaundice is noted. The patient reports that he recently started taking quinine tablets that he borrowed from a friend to treat symptoms of “nighttime restless legs.” He denies taking any other prescription or over-the-counter medications. CBC results reveal a normocytic anemia, and additional laboratory results are as follows:
↑ Total serum bilirubin level
↑ Indirect serum bilirubin level
↑ Reticulocyte count
Peripheral smear: many bite cells are present
Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A patient is noted to have macrocytic anemia with an MCV = 128 on a recent CBC. When reviewing the patient’s chart, you verify that her CBC was normal during her most recent prior physical three years ago. On further questioning, the patient tells you that she has been following a strict vegetarian diet for the past several years. The patient tells you that she has also recently started to have trouble feeling where her feet are on the floor, unless she is looking directly at them. Based on this information, which of the following conditions is the most likely diagnosis for this patient?

Which of the following peripheral blood smear findings would support a diagnosis of megaloblastic anemia?

A 26-year-old male patient who was found to have a normocytic anemia with MCV = 88 on a recent CBC. The differential diagnosis for normocytic anemia includes all of the following conditions EXCEPT:

A 72-year-old male patient was recently diagnosed with severe megaloblastic anemia. The CBC and reticulocyte results are as follows (abnormal results are in bold type):
WBC: 1,900
RBC: 1.4 x 106
Hgb: 5.1 g/dL
HCT: 18%
MCV: 129
Plt: 53,000
Reticulocyte count: 2.5%
Normal male HCT: 45%

Using the information provided, calculate the corrected reticulocyte count (CR) for this patient:

When instituting Vitamin B12 (cobalamin) replacement therapy, it is necessary to monitor the patient for which of the following electrolyte abnormalities?

A 46-year-old male patient presented for initial evaluation one week ago, complaining of mild shortness of breath on exertion, and increasing fatigue. Examination at that time revealed conjunctival pallor and koilonychia (spoon nails). Initial laboratory testing was done, with results as follows (abnormal results are in bold type):
WBC: 7,500
Hgb: 7.5 g/dL
HCT: 24%
MCV: 64
Plt: 530K
Stool: Hemoccult (+)
Serum Ferritin level: 4 g/dL ↓
Serum Iron level: 15 g/dL ↓
TIBC: 520 g/dL ↑
Based on these results, all of the following interventions are appropriate in the management of this patient except?

A 28-year-old female presents for further evaluation of microcytic anemia. She states that she recalls being told that she has ‘an inherited blood condition,’ and as she prepares for her upcoming wedding, she is anxious to learn more about the possibility of passing this along to potential offspring. CBC results are as follows (abnormal results are in bold type):
WBC: 4,800
Hgb: 9.8 g/dL
HCT: 30%
MCV: 60
Plt: 150,000
Hemoglobin electrophoresis results: consistent with Hemoglobin H disease
Based on this information, all of the following statements are correct except?

A 32-year-old male with a history of G6PD deficiency presents for evaluation after taking several doses of nitrofurantoin for a recent UTI. A CBC is ordered. Which of the following additional diagnostic tests results would support a diagnosis of acute hemolytic episode related to G6PD-deficiency?

While evaluating a 45-year-old male patient who was recently diagnosed with severe megaloblastic anemia due to vitamin B12 deficiency, you note the following CBC and reticulocyte results:
WBC: 1600
RBC: 1.5 × 106
Hgb: 5.0 g/dL
HCT: 15%
MCV: 126
Plt: 50,000
Reticulocyte count: 3.0%
Normal male HCT: 45%
Using this information, calculate the corrected reticulocyte count (CR) for this patient:

Which of the following statements regarding the epidemiology of Hodgkin lymphoma is TRUE?

Which of the following types of anemia is clinically diagnosed by the presence of greater than 60% hemoglobin S in red blood cells?

A 19-year-old woman comes to the office due to fatigue for the past few months. She attends college and plays on the university soccer team but despite sleeping several hours per night, she still feels fatigued. She has regular, monthly menses with 5-6 days of heavy bleeding. Blood pressure is 108/62 mm Hg and pulse is 62/min. BMI is 20 kg/m2. Physical examination shows pale conjunctivae. Hemoglobin is 9.7 g/dL. Which of the following sets of additional laboratory findings is most likely to be seen in this patient?

A 27-year-old female with iron deficiency anemia from heavy menses comes to the office due to continued fatigue. She has since been taking oral iron supplements for the last 6 months. Physical examination is normal. Laboratory results are as follows:
Complete blood count
Hemoglobin 10.2 g/dL
Platelets 184,000/mm3
Leukocytes 6,100/mm3

Hematology
Mean corpuscular volume 65 µm3
Erythrocytes 5.9 million/mm3
Red cell distribution width 13.9% (11.5-14.5%)
Ferritin, serum 318 ng/mL(40-200ng/mL)

Which of the following is the best next step in the management of this patient?

A 61-year-old woman with PMHx of DVT on Warfarin comes to the emergency department for evaluation of “coffee ground emesis.” The patient now feels lightheaded and dizzy. Blood pressure is 87/58 mm Hg, pulse is 118/min, and respirations are 20/min. Rectal examination shows maroon-colored, guaiac-positive stool. Which of the following is the best immediate treatment for this patient?

An 9-year-old boy with sickle cell disease is brought to the office for evaluation of bilateral leg pain for 1 day which has gradually worsened. His hydroxyurea prescription has not been filled due to lack of insurance. Temperature is 37.2 C (99 F). Palpation of the bilateral legs shows tenderness, but no erythema or swelling. Complete blood count shows:
Hemoglobin 7.4 g/dL
Mean corpuscular volume 79 fL
Reticulocytes 8.3%
Platelets 490,000/mm3
This patient’s peripheral blood smear most likely has which of the following?

A 34-year-old woman with PMHx of Epilepsy on chronic Phenytoin comes to the office for evaluation of mild fatigue. Vital signs are normal. Examination shows mild gingival hyperplasia and pallor. There is no jaundice or lymphadenopathy. Cardiopulmonary examination is normal. The abdomen is soft and nontender with no hepatosplenomegaly. Hemoglobin is 9.7g/dL and mean corpuscular volume is 118 µm3. Supplementation with which of the following could have prevented this patient’s condition?