Question 1

A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last 2 years. What response by the healthcare professional is most appropriate?
A)"This condition is not transmitted genetically."
B)"We can test your blood for factor V Leiden."
C)"Were they all men or both men and women?"
D)"Familial thromboses tend to be very severe."

Accepted Answer

Factor V Leiden results from a single nucleotide mutation of guanine to adenine at nucleotide 1691 (G1691A) and is the most common hereditary thrombophilia. It is autosomal dominant so would not be confined to one sex. Most people with this disorder do not have clinically significant events.

Question 2

What does the student learn about warm autoimmune hemolytic anemia?
A)Warm autoimmune hemolytic anemia occurs primarily in children.
B)It is self-limiting and rarely produces hemolysis.
C)Erythrocytes are bound to macrophages and sequestered in the spleen.
D)Immunoglobulin M coats erythrocytes and binds them to receptors on monocytes.

Accepted Answer

The immunoglobulin G-coated red blood cells bind to the Fc receptors on monocytes and splenic macrophages and are removed by phagocytosis. This disease occurs mainly in people older than 40 years of age. It is one of the hemolytic anemias and destruction of red blood cells occurs by extravascular processes. The erythrocytes are bound to macrophages, not monocytes.

Question 3

A student asks the professor to explain the jaundice that accompanies hemolytic anemia. Which statement is by the professor is most accurate?
A)Erythrocytes are destroyed in the spleen.
B)Heme destruction exceeds the liver's ability to conjugate and excrete bilirubin.
C)The patient has elevations in aspartate transaminase (AST) and alanine transaminase (ALT).
D)The erythrocytes are coated with an immunoglobulin.

Accepted Answer

Jaundice (icterus) is present when heme destruction exceeds the liver's ability to conjugate and excrete bilirubin. Jaundice is not as directly related to the destruction of the erythrocytes. It is also not related to liver enzyme elevation or being coated with an immunoglobulin.

Question 4

What does treatment for polycythemia vera involve?
A)Therapeutic phlebotomy and radioactive phosphorus
B)Restoration of blood volume by plasma expanders
C)Administration of cyanocobalamin
D)Blood transfusions

Accepted Answer

In low-risk individuals, the recommended therapy is phlebotomy and low-dose aspirin, whereas radioactive phosphorus has been used to suppress erythropoiesis. Plasma expanders, cyanocobalamin, and blood transfusions are not treatments for this disease.

Question 5

A patient has polycythemia vera and presents to the Emergency Department with plethora and neurological changes. The student asks the healthcare professional to explain the primary cause of these symptoms. What response by the professional is best?
A)Decreased erythrocyte count
B)Destruction of erythrocytes
C)Increased blood viscosity
D)Tissue destruction by macrophages

Accepted Answer

As polycythemia vera progresses, many of the symptoms are related to the increased blood cellularity and viscosity. These include plethora, engorgement of the retinal and cerebral veins. Individuals also may experience headache, drowsiness, delirium, mania, psychotic depression, chorea, and visual disturbances. The symptoms of polycythemia vera are not related to decreased erythrocyte counts, destruction of erythrocytes, or tissue destruction by macrophages.

Question 6

Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?
A)Aplastic
B)Sideroblastic
C)Anemia of chronic disease
D)Iron deficiency

Accepted Answer

Anemia of chronic disease specifically results from a combination of (1) decreased erythrocyte life span, (2) suppressed production of erythropoietin, (3) ineffective bone marrow erythroid progenitor response to erythropoietin, and (4) altered iron metabolism and iron sequestration in macrophages.

Question 7

An adult patient has been hospitalized with thrombocytopenia with a platelet count of 8000/mm³. What action by the healthcare professional is most appropriate?
A)Tell the patient not to get out of bed without assistance.
B)Prepare the patient for transfusions of whole blood.
C)Educate the patient on side effects of heparin.
D)Nothing; this finding is normal in an adult.

Accepted Answer

Thrombocytopenia is a platelet count of less than 150,000/mm³. A platelet count of 8,000/mm³ is low enough to produce spontaneous bleeding, which would be devastating if it occurred in the brain. The healthcare professional should advise the patient not to get out of bed without assistance to help prevent falls. Whole blood is not needed since only platelets are deficient. The patient would not receive heparin as this would increase the chance of bleeding. A normal platelet count in an adult is 150,000 to 350,000/mm³.

Question 8

A healthcare professional is evaluating laboratory results for a patient who has disseminated intravascular coagulation (DIC). What results would the professional consider consistent with this condition? (Select all that apply.)
A)Elevated d-dimer
B)Elevated creatinine
C)Decreased protein C
D)Decreased lactate dehydrogenase
E)Increased pH

Accepted Answer

Lab results consistent with DIC include elevated d-dimer and creatinine (showing kidney damage), and decreased protein C. The lactate dehydrogenase would be elevated and the pH would be decreased.

Question 9

A healthcare professional is caring for five patients. Which one would the professional assess for disseminated intravascular coagulation (DIC) as the priority? (Select all that apply.)
A)Heat stroke
B)Severe pancreatitis
C)Term delivery
D)HELLP syndrome
E)Snake bite

Accepted Answer

Common causes of DIC include heat stroke, severe pancreatitis, HELLP syndrome (and other OB complications), and snake bite. A normal term delivery would not put a patient at high risk for developing DIC.

Question 10

A patient is 8 hours postoperative after a long orthopedic procedure. The student asks why this patient is at particular risk of developing a thromboembolism. What response by the healthcare professional is best?
A)Patients tend to have venous stasis from orthopedic operations.
B)Anesthetic agents often cause an immune response against clotting factors.
C)Endothelial damage occurs and repair is slowed by postoperative pain.
D)Atherosclerotic build up causes turbulent blood flow leading to clots.

Accepted Answer

Thromboembolic events are caused by some component of Virchow triad: endothelial injury, abnormal blood flow, and hypercoagulability of the blood. Long operative procedures such as orthopedic cases promote venous stasis. Anesthetic agents are not implicated. Endothelial repair is not appreciably hindered by postoperative pain. Atherosclerotic buildup can lead to endothelial injury but that is not specific to this patient.

Question 11

A patient in the hospital has been receiving heparin injections. The platelet count on admission was 222,000/mm³ and four days later is 113,000/mm³. What action by the healthcare professional is best?
A)Prepare to transfuse the patient with platelets.
B)Do nothing; this is an expected side effect.
C)Switch the heparin to lepirudin
D)Stop all the patient's medications.

Accepted Answer

After initiating heparin in the hospital this patient's platelet count dropped by 51%. A drop in more than 50% of the platelet count is seen in more than 95% of patients with heparin-induced thrombocytopenia. The treatment is to withdraw the heparin and use alternatives such as lepirudin. If the platelet count were severely low, transfusion would be indicated. There is no need to stop all the patient's medications.

Quiz 29: Alterations of Erythrocytes, Platelets, and Hemostatic Function

A patient has been hospitalized for a large deep vein thrombosis and states he is the third person in his family to have this condition in the last 2 years. What response by the healthcare professional is most appropriate?

What does the student learn about warm autoimmune hemolytic anemia?

A student asks the professor to explain the jaundice that accompanies hemolytic anemia. Which statement is by the professor is most accurate?

What does treatment for polycythemia vera involve?

A patient has polycythemia vera and presents to the Emergency Department with plethora and neurological changes. The student asks the healthcare professional to explain the primary cause of these symptoms. What response by the professional is best?

Shortened erythrocyte life span, ineffective bone marrow response to erythropoietin, and altered iron metabolism describe the pathophysiologic characteristics of which type of anemia?

An adult patient has been hospitalized with thrombocytopenia with a platelet count of 8000/mm³. What action by the healthcare professional is most appropriate?

A healthcare professional is evaluating laboratory results for a patient who has disseminated intravascular coagulation (DIC) . What results would the professional consider consistent with this condition? (Select all that apply.)

A healthcare professional is caring for five patients. Which one would the professional assess for disseminated intravascular coagulation (DIC) as the priority? (Select all that apply.)

A patient is 8 hours postoperative after a long orthopedic procedure. The student asks why this patient is at particular risk of developing a thromboembolism. What response by the healthcare professional is best?

A patient in the hospital has been receiving heparin injections. The platelet count on admission was 222,000/mm³ and four days later is 113,000/mm³. What action by the healthcare professional is best?