Hematology Question Set 2

A 35 year old lady presents with complaints of easy fatigability, breathlessness on exertion, and altered sensations in her lower limbs. On examination, she has marked pallor, loss of touch and vibration sense in both her lower limbs. Her CBC is as follows: Hemoglobin: 8.0 g/dL MCV: 112 fL WBC: 2500/mm^3 Platelets 95000/mm^3 The most likely diagnosis is:

8-month-old male infant is brought in for routine checkup by his mother. The child is pale, but other than that, looks healthy, with growth parameters within the expected range. The mother informed that boy was breast fed for three months, followed by cow’s milk substitute. For the last two months, she started giving him fruits and vegetables; however, she still hasn’t introduced eggs and milk into the boy’s diet. Complete blood count (CBC) shows hemoglobin (Hgb) level to be 9g/dL, mean corpuscular volume (MCV) of 65fL, increased total iron binding capacity (TIBC) and low serum iron. Neither mother nor father have a positive family history for any blood disorder. What is the best treatment?

A 5-year-old girl is brought in by her mother because of diffuse rash on her limbs. Upon closer examination, it is clear that the rash is a petechial bleeding. Also, several bruises are visible on her legs. The girl doesn’t remember how she got them. The child doesn’t have any other signs or symptoms, and doesn’t appear to be ill. The mother reports respiratory infection several weeks prior to petechiae and bruising. CBC shows thrombocytopenia (<20x109/L). Other parameters of CBC are within expected range for age. Also, PT, PTT, and metabolic panels are all within reference range. What is the most likely blood disorder?

A 2-year-old boy is brought in by his mother because of the bloody stool after ingestion of unknown amount of rat poison (coumadin based). He is admitted and treated with fresh frozen plasma and vitamin K after his prothrombin time (PT) was found to be prolonged. What is the reason for bloody stool in this case?

A 25-year-old woman of Mediterranean descent goes to her doctor because her skin and sclera became yellow. She complains of fatigue and fever that started at the same time icterus appeared. On examination, she is tachycardic and tachypneic. Her O2 saturation is below 90%. She has increased unconjugated bilirubin, hemoglobinemia, and increased number of reticulocytes in peripheral blood. What is the most likely diagnosis?

Asplenic patients are prone to infectious diseases due to reduced functioning of the spleen. Which of the following case can be a serious medical threat and requires emergency call in such patients?

A 40-years old male visits your clinic. The patient is on vitamin-E supplementation in order to slow down the aging process and increase his sexual output, without any healthcare-professional’s recommendation. The patient is also not deficient for this vitamin. This male is interested in knowing if it is alright to continue with his supplementation. Tel him what particular side-effect he should be concerned about?

A patient suffering with hepatitis-C is under treatment. The treatment options for this patient include pegylated interferon with ribavirin oral. Which side-effect is most likely to occur in this patient?

A 69-year-old unconscious woman is rushed to the emergency room by her daughter. Bruises are visible on her torso and limbs and it is evident that she has epistaxis. Her daughter says that the patient was diagnosed with immune thrombocytopenic purpura at the age of 61 and has never had normal thrombocyte count again. She was treated with corticosteroids but stopped taking the drug several weeks ago. Her current thrombocyte count is 4000x109/L. Which of the following is the most appropriate treatment in the present case?

A 78-year-old man comes in for a routine checkup to his health care provider. He is pale and complains of fatigue and dyspnea, even after a mild exertion. Further examination reveals that he is taking a rich diet including eggs and meat. Complete blood count (CBC) and blood smear show normochromic, normocytic anemia. Other CBC parameters are within normal range and blood smear doesn’t show pathology of other cell lineages. Other findings in the lab reports include decreased serum levels of iron, TIBC (total iron binding capacity) and increased levels of ferritin. However, he claims that he was not anemic as a child or during his adulthood. Which of the following is the most probable diagnosis?

A 19-years-old girl comes for a regular check up with her hematologist. She was diagnosed with immune thrombocytopenic purpura (ITP) at the age of 8 and has never had a normal thrombocyte count again. At this moment, she has petechial bleeding and bruises on her torso and limbs that started appearing after she stopped taking corticosteroids. She also shows signs of Cushing’s syndrome. Her ITP is corticodependent. Which of the following is the possible treatment in this case?

A 9-years-old boy is brought in by his mother because of petechial bleeding and bruises on his torso and limbs. The child doesn’t have any other signs or symptoms and doesn’t appear to be ill. CBC and PT values are completely normal; however, value for aPTT is prolonged. Which of the following is the most probable diagnosis in the present case?

A 16-year-old adolescent male presented to a hematologist with history of long-standing anemia. He had history of prolonged neonatal jaundice and he had repeated episodes of jaundice without fever. His physical examination showed pallor, icterus and splenomegaly. His hemoglobin was 10 g/dL; examination of peripheral smear showed red cell basophilic stippling. Which of the following is the most probable diagnosis in the present case?

A 68-year-old man, a case of ischemic stroke due to right middle cerebral artery thromboembolism, is being examined by a physician. Apart from abnormal neurologic findings, the physician finds presence of hepatosplenomegaly and multiple lymphadenopathy. At time of admission, his laboratory investigations were as follows: hemoglobin 9.5 g/dL, while blood cell count 13, 600 mm^3, platelet count 95,000/mm^3, urine examination normal except for presence of Bence-Jones proteins. Bone marrow examination showed small lymphocytes admixed with plasmacytoid lymphocytes and plasma cells, increased mast cells, and presence of Russell bodies and Dutcher bodies in plasma cells. He was referred to a hemato-oncologist, who confirmed diagnosis of lymphoplasmacytic lymphoma after further laboratory evaluation. Which of the following infectious agents is associated with development of lymphoplasmacytic lymphoma in the present case?

A preterm neonate, born at 28-weeks of gestation, is in neonatal intensive care unit as he developed respiratory distress on 4th hour after birth. On 2nd day of life, he required ventilator support. Today, on 5th day of life, he developed generalized purpura and hemorrhagic aspirate from stomach. His laboratory work-up is suggestive of thrombocytopenia, prolonged prothrombin time, and prolonged activated partial thromboplastin time. Which of the following statements is incorrect regarding coagulation system of neonates in the present case?

A 5-year-old boy presented with history of loss of appetite, fatigability, unexplained irritability and intermittent low-grade fever for last 1 month. He often had bone pains, especially in lower limbs. Physical examination was significant for presence of pallor, splenomegaly, and generalized lymphadenopathy. His leg bones were tender, but there was no joint swelling. His initial laboratory investigations showed hemoglobin 8.0 g/dL, total white blood cell count 8900/mm^3 with presence of atypical lymphocytes on peripheral smear, and platelet count 90,000/mm^3. As the pathologist suggested a possibility of leukemia, bone marrow evaluation was done, which demonstrated 30% of the bone marrow cells as a homogeneous population of lymphoblasts. Immunophenotyping confirmed the diagnosis of acute lymphoblastic leukemia of precursor-B subtype. Which of the following chromosomal abnormality is associated with an unfavorable prognosis?

A 22-year-old young man complains of recurrent joint pain that migrates from joint to joint and intermittent fever for several weeks. He has lost appetite and weight lately. He is pale with diffuse petechial bleeding and bruises on his legs. Upon clinical examination, he is found to have hepatomegaly and splenomegaly. Ultrasound of the abdomen confirms hepatosplenomegaly and shows enlarged mesenterial lymph nodes. Complete blood count (CBC) showed severe anemia and thrombocytopenia with leukocytosis. What is the most likely diagnosis in this case?

A 32-year-old woman complains of fatigue and pallor. Symptoms started several months ago and have been becoming more serious with time. She has tachycardia, but other than that, her physical status is normal. Complete blood count shows anemia with low MCV (mean corpuscular volume) and peripheral blood smear shows small erythrocytes. She is vegan and doesn’t take any supplementation. Which of the following is most probable diagnosis in the present case?

A 5-year-old girl is brought in for a routine checkup. She is pale and parents said that she looks tired lately. Upon examination, several bruises are seen as well as petechial bleeding on her limbs. Her family history is unremarkable. Blood count shows leukocytosis with severe anemia and thrombocytopenia. Peripheral blood smear shows 35% of blasts. Ultrasonography of the abdomen shows hepatosplenomegaly and chest X-ray shows mediastial mass. Which of the following is most probable diagnosis in the present case?

A 15-year-old boy comes to emergency room because of malaise, dyspnea and yellow color of his skin and sclera. On examination, he is tachycardic and tachypneic and his O2 saturation is below 90%. He has increased levels of unconjugated bilirubin, hemoglobinemia and increased number of reticulocytes in peripheral blood. What is the most likely diagnosis in the present case?

A 67-year-old female presents to your clinic with a 9-month history of seeing bright red blood in the toilet after defecating. Additional complaints include fatigue, shortness of breath and mild lethargy. She denies loss of weight, abdominal pain or changes in dietary behavior. She consumes a balanced diet and takes a multiple vitamin every day. Current vitals include a temperature of 37 °C, (98.6 °F), pulse: 68/min, blood pressure: 130/81 mmHg, and a respiratory rate of 13/min. Upon examination, you notice increased capillary refill time and pale mucosa. What are the likely findings on:

A 38-year old male presents to the emergency department due to severe alcohol intoxication. The patient is agitated and refuses to answer any questions in regards to his medical history. The patient’s vitals are within normal limits. Complete blood count demonstrates hemoglobin at 11.5 g/dL, hematocrit of 39 % and mean corpuscular volume of 77 μm3. Using a special dye demonstrates blue colored rings in the peripheral smear.

A 23 year-old Caucasian man presents to his primary care physician after a week-long history of bleeding gums while brushing his teeth. He has no family history available due to adoption. Physical exam is normal. Screening lab work is ordered with the following values: Platelet count: normal; Bleeding time: normal; PT: normal; aPTT: increased; Factor VIII activity: decreased; Ristocetin cofactor assay: decreased. He is subsequently sent to a Hematologist for further work-up and potential treatment. Which of the following aspects of coagulation are most likely affected in this patient?

A 43 year-old man presents to the ER with nausea and vomiting. This has been going on for the past 4 hours, progressively worsening. There was no blood seen. Vital signs reveal a temperature of 39.5 °C (103.2 °F). History is significant for a recent colonoscopy that was performed due to a family history of colon cancer. While the colonoscopy was negative as the time, further imaging in the ER reveals a colon perforation that was presumptively caused by the procedure. Routine lab tests reveal an elevated WBC with left shift, decreased platelet count, increased PT and PTT and slightly decreased hemoglobin/hematocrit. In addition, his bleeding time was prolonged. Which of the following is most closely related to his increased bleeding time?

A 40 year-old African-American female presents to the ER with severe left upper quadrant pain. Duration 3 hours, stabbing quality, 10/10 on the pain scale. Physical exam confirms her pain distribution, and splenomegaly is noted. There is a significant past medical history of sickle cell anemia. She is admitted to the hospital for close observation and placed on DVT prophylaxis as part of routine protocol. Routine blood work later demonstrates a normal PT and elevated PTT. Which of the following factors is most directly affected by her DVT prophylaxis?

A 34-year-old man presents to the clinic with complaints of dysphagia. Upon examination, he looks pale, his tongue appears swollen with a beefy red color. Additionally, he presents with angular stomatitis. He also reports he has been recently in the Caribbean on a work trip and that there has been no change in his diet. The patient is currently taking no medications. Laboratory results show macrocytic, megaloblastic anemia, decreased serum folate, increased serum homocysteine and normal methylmalonic acid levels. Which of the conditions below could have caused the symptoms in this patient?

A 10-month-old boy is being treated for a rare kind of anemia and the child is currently being evaluated for a bone marrow transplant. The mother comes to an appointment with their pediatrician after having done research online. She has learned that a vast majority of patients can inherit the condition in an autosomal dominant manner. As a result, erythropoiesis is impaired leading to macrocytic red blood cells without hypersegmented neutrophils. She also read that children who thrive will eventually present with short stature and craniofacial abnormalities. What is true about the treatment this boy’s condition?

A 35-year-old woman is involved in a car accident and is taken to the hospital with a trauma to the left femur and severe bleeding from the femoral artery. She has a bounding pulse and presents with lethargy, tachycardia, and confusion. Blood pressure is fixed at 90/60 mm Hg. When she arrives at the hospital lab works show a hemoglobin level of 6 g/dl. Her husband reports that prior to the accident she was otherwise healthy. What is true about the woman's condition?

A 10-year-old African American girl with previously diagnosed sickle cell anemia presents to the emergency room with a low-grade fever, malaise, and petechiae on her arms and a lacey rash on her face. She regularly takes hydroxyurea and blood transfusions to treat her condition. Her blood tests show hemoglobin of 4.0 g/dL; MCV 87 fl; and 2% reticulocyte count. A bone marrow biopsy shows is described as a dry, empty bone marrow tap. What is the most likely diagnosis?

A clinical trial is being run with patients that have a genetic condition that is characterized by abnormal hemoglobin that can undergo polymerization under hypoxia, acidosis or dehydration. This process of polymerization is responsible for the distortion of the red blood cell that acquires a crescent shape and the hemolysis of red blood cells. Researchers are studying the mechanisms of the complications commonly observed in these patients such as stroke, aplastic crisis and auto-splenectomy. What kind of mutation leads to the development of the disease?

A 10-year-old boy with trisomy 21 arrives at his annual check up with his pediatrician. His parents explain that over the past week he has been increasingly withdrawn and lethargic. On exam. Lymph nodes appear enlarged around the left side of his neck, otherwise there are normal findings. The pediatrician orders some routine blood work. These are the results of his complete blood count: WBC: 30.4 k/uL; RBC: 1.6 m/uL; Hemoglobin: 5.1 g/dL; Hematocrit: 15 %; MCV: 71 fL; MCH: 19.5 pg; MCHC: 28 g/dL; Platelets: 270 k/uL; Differential: Neutrophils: 4 %; Lymphocytes: 94%; Monocytes: 2 %. Peripheral smear demonstrated some evidence of immature cells and the case was referred to hematopathology. On flow-cytometry, the cells were found to be CALLA (CD 10) negative. Which of the following diseases is most associated with these clinical and cytological findings?

A 34-year-old Asian man presents to the emergency room with chronic fatigue and enlarged lymph nodes in his neck, right armpit and groin. Upon questioning he reveals he frequently visits Japan on business and is rather promiscuous on his business trips. He denies use of barrier protection. Routine lab work reveals abnormally high levels of calcium and abnormal lymphocytes on peripheral smear. Which of the following viruses are strongly associated with the development of this condition?

A 61 year-old Caucasian male presents to the ER with abdominal discomfort and malaise over the past 2 weeks. He states he is married and monogamous. He is found to have a fever of 39 C (102.9 F) and complains of night sweats as well. On physical exam he demonstrates an enlarged spleen with mild tenderness and pale nail beds. There is mild erythema on his tonsils and a pulmonary exam demonstrates scattered crackles. A complete blood count demonstrates anemia, thrombocytopenia and leukocytosis with lymphocytic predominance. Findings on peripheral blood smear result in a bone marrow aspiration to be scheduled the next morning, which were ruled inconclusive due to a low yield. Regardless, the patient was admitted due to concerns over his anemia and given a transfusion of packed red blood cells as well as wide spectrum antibiotics. He is released home the next day with instructions for primary care follow up. Which of the following laboratory findings is most reliably positive for the primary cause of this illness?

A 34 year-old Caucasian woman presents to her primary care physician for a routine check-up. She complains that she is feeling out of sorts but has no specific complaint. After a routine examination he orders a full thyroid workup including TSH, T3 and Free T4. He also refers her directly to an oncologist for an initial consult. Which type of lymphadenopathy was most likely present during physical examination that made the primary care physician react this way?

A 51 year-old Asian female presents to her primary care provider with abdominal pain. On examination she is found to have rebound tenderness in the lower right quadrant of her abdomen. Further workup suggests ovarian cancer, which is confirmed later in the week to be stage IV with confirmed distant metastases in the lungs and brain. Which of the following routes describes a likely lymphatic route for this malignancy to have affected the brain?

A 47 year-old female presents to her primary care physician complaining of joint pain in her fingers, of a two year duration. She states that she hasn’t wanted to be a bother and so delayed seeing a physician for this issue. Her pain is worse in the morning, decreasing throughout the day. On examination her finger joints are enlarged and inflamed, sparing the distal interphalangeal joints. Several enlarged lymph nodes are noted on physical exam. Which of the following patterns of reactive lymphadenitis are most commonly associated with this presentation?

A 77 year-old woman presents to the ER with complaints of malaise, fever and night sweats. She recently observed an enlargement of her axillary lymph nodes, which she checks weekly despite advancing age. She has a remote history of breast cancer in her 60s, which was treated with radiation and chemotherapy. She also reports a history of extensive travel to Africa and a 30-pack year history of smoking. On physical exam several nodes appear involved, with a large non-tender palpable mass measuring 10 cm. Fine-needle aspiration demonstrates what the pathologist describes as “a centroblastic and immunoblastic cell presence, suspicious for Non-Hodgkin Lymphoma (NHL), diffuse large B-cell variant.” Which of the following are known risk factors for NHL?

A 6 year-old African boy is brought to a primary care provider by his adoptive parents for evaluation of a three month history of jaw swelling. He has a positive travel history of recent immigration from equatorial Africa, where his deceased mother was positive for HIV and died from related complications. On physical exam, extensive lymph node swelling on the left side of his jaw is noted. There is also an ulceration that appears to be infected. Fine needle biopsy of the lymph node yields a determination of Burkitt lymphoma by the pathologist. Which of the following aspects of this case are most associated with the involvement of lymph nodes around his jaw?

A 68-year-old Caucasian male presents to his primary care physician for a routine check-up. He currently has no complaints. Over the course of routine blood work he is found to have a slightly elevated calcium (10.4 mg/dL) and some findings of plasma cells in his peripheral blood smear (less than 10 %). His physician orders a protein electrophoresis which demonstrates a slight increase in the gamma protein that is found to be light chain predominate. What is the most likely complication for this patient as this disease progresses if left untreated?

A 61-year-old Caucasian female presents to her primary care physician for a routine check-up. Physical examination demonstrates asymmetric peripheral neuropathy in her feet. The patient has no previous relevant history and denies symptoms of diabetes. Routine blood work shows normal results, she is referred to a hematologist. Subsequent serum protein electrophoresis demonstrates a slightly elevated gamma globulin level, and monoclonal gammopathy of undetermined significance is diagnosed. Which of the following diseases is most likely to develop over the course of this condition?

A 61- year-old Caucasian male presents to the ER with new onset dizziness. Upon further inquiry there are also symptoms of confusion, headaches and loss of coordination. His wife mentions he has had frequent nosebleeds. Physical examination demonstrates double vision. Routine bloodwork demonstrates a normal PT, PTT and a slightly reduced platelet count. CT imaging of his head is normal. After a prolonged hospitalization, numerous reference lab tests yield an elevated IgM spike on serum protein electrophoresis. The hematologist on call suspects Waldenstrom Macroglobulinemia. Which of the following therapies will best address these symptoms?

A 45-year-old Caucasian female presents to the emergency department after sustaining a gun shot wound to her shoulder. During the course of the physical exam, the physician notes her spleen is palpable 10 cm below the costal margin. While this was considered an incidental finding at the time, she was referred to a primary care physician to investigate. Subsequent biopsy demonstrated the splenomegaly was caused by an infiltrative process. Which of the following processes would result in splenomegaly in that patient?

A 46-year-old African-American female presents to her primary care physician with complaints of increasing left upper quadrant discomfort. The patient has a known history of Gaucher disease. On examination her spleen in palpable 8 cm below the costal margin. Routine lab work reveals severe cytopenia. After consultation with the patient on the risks of this condition, the patient decides to undergo a splenectomy. Which of the following conditions are more likely to occur as a consequence of splenectomy?

A 62-year-old retired professor comes to the clinic with complaints of back pain and increasing fatigue over the last four months. For the past one week, his back pain seems to have worsened with radiation to the legs and burning in nature, 6/10 in intensity. There are no associated paresthesias. He has lost 4kg weight in the past two months. There is no history of trauma to the back. Past medical history includes hypertension which is controlled with medications. Physical examination is normal. Laboratory studies show normocytic normochromic anemia. Serum calcium and total proteins are raised. Protein electrophoresis shows monoclonal spike. X-ray of the spine shows osteolytic lesions over L2-L5 and right femur. Bone marrow biopsy reveals plasmacytosis. Which of the following is the most preferred treatment option?

A 52-year-old postmenopausal woman comes to the clinic with complaints of back pain and increasing fatigue over the last six months. For the past one week, her back pain seems to be radiating to the legs and is stabbing in nature, 7/10 in intensity. There are no associated paresthesias. She has unintentionally lost 10 pounds in the past six months. There is no history of trauma to the back. Her past medical history is insignificant and she does not take any medications. Physical examination is normal. Her laboratory results are as follows: Hemoglobin: 10 g/dL; Hematocrit: 30 %; Mean corpuscular volume: 80 μm3; Serum creatinine: 1.5 mg/dL; Serum total protein: 9 g/dL; Serum albumin: 4.2 g/dL; Serum calcium: 11.2 mg/dL. Peripheral smear shows normocytic normochromic cells. X-ray reveals multiple osteolytic lesions in the vertebra and long bones. Serum protein electrophoresis shows monoclonal spike. A bone marrow biopsy shows increased plasma cells making up more than 50 % of the total cell population. Which of the following is the most likely diagnosis in this patient?

A 30-year-old woman presents to the emergency department in a state of confusion and disorientation that started this morning. She is accompanied by her husband who says that she has been unwell for about one week. She has been complaining of fatigue. Her husband says this morning she also complained that her urine was dark red in color and that there were some red spots over her legs. He did notice some changes in her level of consciousness that worsened over time and he decided to bring her in today. She does not have a significant medical history. Physical examination shows petechiae over her arms and legs. She is conscious but drowsy and disoriented and unable to answer the physician’s questions appropriately. Her temperature is 101 °F, blood pressure is 160/100 mm Hg, pulse rate is 90/min, and respiratory rate is 20/min. Laboratory studies show: Hemoglobin: 10g/dl; Leukocyte count: 9000/mm^3; Platelet count: 30000/mm^3; Bleeding time: 10 minutes; Prothrombin time: 12 seconds; Activated partial thromboplastin time: 30 seconds; D-dimer: 0.4mg/L (normal <0.5mg/L); Serum fibrinogen: 350 mg/dL (normal 200-400 mg/dL); Serum bilirubin (total) - 2.5mg/dL: 2.5 mg/dL; Serum bilirubin (indirect) – 2.2mg/dL: 2.2 mg/dL; Serum creatinine –1.5mg/dL: 1.5 mg/dL; Serum LDH – 1010 U/L: 1010 U/L. Peripheral smear is shown (image). Based on her history, physical and laboratory findings, which of the following is the most likely pathophysiology for her presentation?

Following a recent myocardial infarction, a 60-year-old woman has been started on multiple medications at time of discharge from hospital. After 10 days of discharge, she presents to emergency department with history of fever, headache, and dark colored urine for two days. Her husband mentions that she has not passed urine for the last 24 hours. Her physical examination shows significant pallor and multiple petechiae are present all over her limbs. Her temperature is 102° F, pulse rate is 94/minute, blood pressure is 124/82 mm Hg, and respiratory rate is 16/minute. Her sensorium is altered with absence of spontaneous speech and spontaneous movements. She responds inappropriately to verbal stimuli. Her laboratory investigations reveal presence of anemia and thrombocytopenia. Examination of peripheral blood smear shows presence of schistocytes. Serum creatinine is 2 mg/dL. Serum levels of fibrinogen, fibrin monomers, fibrin degradation products, and D-dimers are normal. Prothrombin Time (PT) and activated Partial Thromboplastin Time (aPTT) are normal. Which of the following is therapy of choice for treatment of this patient?

A 67- year old African American female comes to the clinic complaining of progressive fatigue for the past 4 months. She noticed that she is feeling increasingly short of breath after walking the same distance from the bus stop to her home. She denies chest pain, syncope, lower extremity edema or cough. She denies difficulty breathing while sitting comfortably but increased difficulty upon walking or other mildly strenuous activity. Her past medical history includes mild osteoporosis and occasional gastric reflux disease. She takes oral omeprazole as needed and daily baby aspirin after her husband died of cardiovascular complications. The patient is a retired accountant and denies smoking history but does admit to 1 small glass of red wine daily for the past 5 years. Her diet is varied, having devoutly following a Mediterranean diet of fruits, vegetables and fish. She states with pride that she has been very healthy previously, having managed her own health without a physician for the past 20 years. On physical examination, her blood pressure is 128/72 mmHg, pulse is 87 beats/min and oxygenation of 94% on room air. HEENT examination demonstrates mild conjunctival pallor. Lung and abdominal examinations are within normal limits. Heart examination reveals a 2/6 systolic murmur at the right upper sternal border. The following laboratory values are obtained: Hematocrit: 29 % Hemoglobin: 11 mg/dL Mean red blood cell volume: 78 fl Platelets: 240,000/mm^3 White blood cells: 6,000/mm^3 What is the most likely reticulocyte range for this patient? (Normal: 0.5- 1.5 %)

A 13-year-old boy is being evaluated for failure to thrive and bad performance at school. He has a history of microcytic anemia and takes a multivitamin every morning with breakfast. An electrophoresis analysis shows no HbA, elevated HbA2 and normal HbF. A skull x-ray revealed a “crewcut” appearance. Which of the following is the most likely diagnosis?

A 29-year old woman is on vacation in Mexico and is admitted to the emergency department due to severe symptoms of intoxication and unexplained convulsions. She is accompanied by her husband, who reports she takes disulfiram. There is no prior history of epilepsy or in the family. She shows signs of confusion, hyperirritability and disorientation. On further evaluation, the patient is noted to have stomatitis, glossitis, and cheilosis. A chest x-ray is unremarkable. The deficiency of which of the vitamins below is likely to be the major cause of this patient’s symptoms?

A 25-year-old woman is being evaluated for fatigue and pink urine. Labs reveal Hb 6.7, red blood cell count 3.0 10^12 /L, leukocyte count of 5,000/mm^3, platelets of 170 x 10^9/L, reticulocyte count 2 %, hematocrit 32 %. The physician thinks that the patient is suffering from an acquired mutation in hematopoietic stem cells, which is confirmed by flow cytometry analysis that revealed these cells to be CD55 and CD 59 negative. The physician is interested, however, in knowing the corrected reticulocyte count before starting the patient on eculizumab, after calculations, he finds out that it is equal to:

An 8-year old African American boy who is known to suffer from a genetic condition in which the substitution of thymine for adenine in the sixth codon of the beta globin gene leads to a single-point substitution mutation that results in the production of the amino acid valine in place of glutamic acid. The patient comes to the clinic regularly for blood transfusions. Which of the findings below can be observed in the laboratory work of this patient?

A 27-year-old male that immigrated to the United States from Poland with his family has been recently diagnosed with an autosomal dominant disorder that causes anemia by extravascular hemolysis. The doctor explains that his red blood cells are spherical, which decreases their lifespan and explains that a splenectomy may be required. What is defective in the described condition?

A 48-year-old man is being evaluated for an acquired defect of the myeloid stem cell line with a mutation in the PIG-A gene. His diagnosis was first suspected due to anemia and spontaneous and recurrent pink tinged urine. Which of the markers will be negative in flow cytometry test for his condition?

A 2-year-old child of African American descent is being evaluated for an autosomal-recessive condition that produces valine instead of glutamine in the β-globin gene. On further examination, the patient’s x-ray showed a crew cut appearance of the skull. All the statements about his condition below are true, except for:

A clinical study is studying new genetic gene-based therapies for children and adults with sickle cell disease. The patients were informed that they were divided into two age groups since younger patients suffer from different complications of the disease. The pediatric group is more likely to suffer from which of the complications? I. Splenic sequestration II. Avascular necrosis III. Pulmonary hypertension IV. Acute chest syndrome V. Nephropathy

A 21-year-old college student is admitted to the emergency department with complaints of pharyngitis, headache, and a persistent, non-productive, dry, hacking cough. The patient reports no fever but complains about fatigue. On examination her mucosa is pale. A complete blood count is remarkable for decreased hemoglobin. The physician suspects viral pneumonia, but the sputum culture tests come back with the following description: "Fried-egg shaped colonies on sterol-containing media, mulberry-shaped colonies on media containing sterols". A direct Coombs test comes back positive. All statements below are true for the complication associated with Mycoplasma pneumonia, except for:

A 6-year-old child is brought to the emergency department due to a severe infection. Laboratory work shows leukocytosis of 60 × 10^9/L with marked left shift, but no blast cells. The patient is febrile and dehydrated. The physician believes that this is a severe reaction to the infection and orders a leukocyte alkaline phosphatase (LAP) stain on a peripheral smear. The LAP score is elevated. Which of the following phrases best describes an additional characteristic of the condition this child is suffering from?

A 39-year-old man presents to the emergency department with complaints of “cola”-colored urine that he noticed only today. Additionally, he complains of malaise and reports he hasn’t been able to be productive at work. Labs reveal Hb 6.7 g/dL, leukocyte count of 1,000 cells /mm^3, and a high reticulocyte count. Coombs test was negative. Flow cytometry was positive for CD55/CD59-negative RBCs. Concerned about the results of his complete blood count, his physician explains the mechanisms behind the neutropenia to the patient to raise his awareness of the risks of infection. Which mechanisms below are known to cause neutropenia? I. Decreased activation of neutrophil adhesion molecules II. Increased release of neutrophils in the bone marrow III. Decreased production of neutrophils in the bone marrow IV. Increased destruction of neutrophils V. Increased activation of neutrophil adhesion molecules

A 10-year-old boy from Sri Lanka suffers from an autosomal dominant condition, the hallmark of which is hyperimmunoglobulinemia E and eosinophilia. He suffers from recurrent infections and takes antibiotic chemoprophylaxis. A STAT3 mutation analysis has been performed to confirm the diagnosis of Job syndrome. What combination of symptoms is characteristic of this condition? I. Eosinophilia II. Eczema III. Hay fever IV. Atopic dermatitis V. Recurrent skin and lung infections VI. Bronchial asthma

A blood sample is being analyzed in the laboratory. It comes from a 7-year-old patient that was admitted due to a sore throat, fever, generalized malaise, and a diffuse white exudate on both tonsils. On physical examination, the patient had palpable splenomegaly and mild hepatomegaly. The laboratory describes the blood smears as having large and abundant lymphocytes with blue-gray cytoplasm, irregular nuclei and dark chromatin with inconspicuous nucleoli. These lymphocytes are called “atypical”. All conditions below can present with atypical lymphocytes, except for:

A 17-year-old is admitted to the emergency department with a history of fatigue, fever up to 104F (40 °C), sore throat, and enlarged cervical lymph nodes. On examination, his spleen and liver are unpalpable. A complete blood count is remarkable for atypical reactive T-cells. An examination of his tonsils is shown in the image below. Everything below about the patient's condition is true, except:

A 21-year-old woman presents to her primary care physician for evaluation of malaise, joint pains, and rash. She has developed joint pain in her hands over the last month and has noted a rash over her face that gets worse with sun exposure. She is taking no medication at the present time. On further examination, an erythematous rash with a small amount of underlying edema seen on her face. Her complete blood count is remarkable due to a lymphocytopenia. What are other disorders are known to cause lymphocytopenia?

A 70-year-old retired police officer is being evaluated for fatigue. A peripheral smear shows extremely elevated numbers of immature myeloid cells, which are positive for myeloperoxidase and a translocation t(15,17). Which of the following statements is true regarding his condition?

A three-year-old girl is brought by her parents to the office for bloody diarrhea and a seizure. The parents say she started having fever, abdominal pain and diarrhea about three days ago but the bloody diarrhea started 12 hours ago. The seizure was the last symptom to appear three hours ago and it consisted in repetitive movement of arms and legs with loss of consciousness. Two weeks ago her four-year-old brother had a similar case with bloody diarrhea. Her vital signs are: heart rate: 120/min; respiratory rate: 25/min; temperature: 39.2 °C (102.56 °F); and blood pressure 130/85 mmHg. On physical exam she looks pale and sleepy, her cardiopulmonary auscultation is normal, the abdomen is painful on palpation and the rest of the physical exam just reveals the presence of disseminated pinpoint petechiae. The urinalysis show hematuria. The Coomb’s test is negative. The blood count shows: Hemoglobin: 7 g/dL Hematocrit: 25 % Leukocyte count: 17,000/mm^3 Neutrophils: 70 % Bands: 2 % Eosinophils: 1 % Basophils: 0 % Lymphocytes: 22 % Monocytes: 5 % Platelet count: 37,000/mm^3 Her coagulation tests are as follows: Partial thromboplastin time (activated): 30 seconds; Prothrombin time: 12 seconds; Reticulocyte count: 1 %; Thrombin time: <2 seconds deviation from control. What is the most likely diagnosis?

A hospitalized 70-year-old female, who recently underwent orthopedic surgery, during her seventh day of hospitalization develops severe thrombocytopenia of 40,000/mm3. She has no other symptoms and has no relevant medical history. All the appropriate post-surgery prophylactic measures had been taken. Her labs from the seventh day of hospitalization are shown here: The blood count shows: Hemoglobin: 13 g/dL Hematocrit: 38 % Leukocyte count: 8,000/mm^3 Neutrophils: 54 % Bands: 3 % Eosinophils: 1 % Basophils: 0 % Lymphocytes: 33 % Monocytes: 7 % Platelet count: 40,000/mm^3 Her coagulation tests are as follows: Partial thromboplastin time (activated): 35 seconds Prothrombin time: 14 seconds Reticulocyte count: 1.2 % Thrombin time: <2 seconds deviation from control. Her lab results from previous days were within normal limits. What is the most likely cause of his thrombocytopenia?

A 34-year-old woman comes to the office due to a pulmonary embolism confirmed by CT Chest Angiogram, which she was recently hospitalized for. She doesn’t have any recent surgical, traumatism or travel history. She refers having episodes where her hand fingers become white and then blue, and they are usually accompanied by pain in the same region. These episodes tend to happen more frequently during winter and have been ongoing for about two years now. She also had a spontaneous abortion at 12 weeks gestation last year. She doesn’t have family history of venous thromboembolic disease. Her heart rate is 76/min, her respiratory rate is 18/min, her temperature is 37.2 °C (98.96 °F) and her blood pressure is 120/80 mmHg. Physical examination is non-contributory. The blood count shows: Hemoglobin: 14.2 g/dL Hematocrit: 39 % Leukocyte count: 4,950/mm^3 Neutrophils: 59 % Bands: 3 % Eosinophils: 1 % Basophils: 0 % Lymphocytes: 31 % Monocytes: 4 % Platelet count: 120,000/mm^3 Her coagulation tests are as follows: Partial thromboplastin time (activated): 56 seconds Prothrombin time: 15 seconds Reticulocyte count: 1.0 % Thrombin time: <2 seconds deviation from control What of the following diagnostic tests would be more appropriate?

A 68-year-old woman is being evaluated for a follow-up visit after the implantation of a prosthetic aortic valve. A complete blood count reveals hemoglobin of 9.5 g/L, reticulocyte percentage of 1.8%. Additionally, serum haptoglobin is decreased and the number of platelets is within normal range. The patient reports she has been feeling more tired than usual, but associated that to her recent surgery. The patient is suspected to suffer from a kind of hemolytic anemia secondary to her prosthetic heart valve. Which blood smear finding would confirm the diagnosis?

An 18-month-old boy is brought in by his father for a routine checkup. His complete blood count (CBC) shows moderate neutropenia (500-1000x10^9/L) without disturbances in other parameters of CBC (he is not anemic and thrombocyte count is within normal range). The child looks healthy, eats well and is within expected growth parameters for his age and sex. Bone marrow examination shows normal bone marrow and peripheral blood smear shows normal cell morphology. Which of the following is the most probable diagnosis in the present case?

A 76-years-old woman comes in for a routine checkup to her doctor. She is pale and complains of fatigue and dyspnea, even after mild exertion. She is not tachycardic and her blood pressure is slightly high. She reported that she is consuming a diet rich in eggs and meat. Complete blood count (CBC) and blood smear show normochromic, normocytic anemia. Other CBC parameters are within normal range, except reticulocyte count that is low. Blood smear doesn’t show pathology of other cell lineages. Her fecal occult blood test is negative. What is the most probable cause of her anemia?

A 72-year-old man comes to his doctor for a regular check-up. He says he has been feeling a bit more tired lately but doesn’t complain of any other symptoms. His physical status is completely normal. Complete blood count (CBC) showed lymphocytosis and the last few CBCs show the same. Bone marrow examination shows normocellular bone marrow with 35% of monoclonal lymphocytes. Ultrasound of the abdomen shows no organomegaly or lymph nodes enlargement. What is the most likely diagnosis?

A 24-year-old woman complains of intermittent fever and joint pain. She says these symptoms are present since the last month. Before that, she had no signs and symptoms and was always completely healthy. She has also lost appetite and weight. Complete blood count (CBC) showed severe pancytopenia. What is the next best step for this patient?