Hematological Disorders

below
. 56-1. A hemoglobin concentration
which of the following thresholds would
indicate anemia in an iron-supplemented
pregnant woman in any trimester?

a. 9.0 g/dL b. 9.5g/dL c. 10.0g/dL d. 10.5

g/dL
2. 56-2. What is the most common cause of
antepartum anemia inpregnant women?
a. Thalassemia
b. Iron deficiency
c. Folicacid deficiency
d. Anemiaof chronic disease
3. 56-3. A 19-year-old primigravida at 29
weeks' gestation is noted to have anemia
with a hemoglobin concentration of 8 gldL.
The peripheral blood smear below is
obtained. Which of the following laboratory
findings are likely to accompany this
condition?
 o
Rwkr EDinders of tn metabohen. In Likhtman
Repnah wih molsy, Kih New Yok, MeCiraw

a. Decreased serum ferritin level

b. Elevated mean corpuscular volume
c. Decreased total iron binding capacity
d. Positive sickle-cellscreen (Sickledex)result
56-4. For the patient described in Question 56
3, what isthe most appropriate initial treatment?
a. Red cell transfusion
b. Folic acid, 4 mg orally daily
c. Hydroxyurea, 1 g orally daily
d. Elemental iron, 200 mg orally daily
56-5. Of medical conditions associated with
anemiaof chronic disease, which is most
frequently encountered in pregnancy?
a. Crohn disease
b. Hodgkin lymphoma
c. Chronic renal insufficiency

d. Systemiclupus erythematosus
56-6. A 36-year-old G3P2 at 18weeks'
found to
gestation reportsextreme fatigueand is g/dL.
of 7.5
be have a hemoglobin concentrationvolume is
The erythrocyte mean corpuScular
markedly elevated and measures 124 fL. A
peripheral blood smear is obtained and is shown
here. What is the most likely etiology?

Reroducod uh nrmson fon Girccn R: Faate. cohalamin, and meealoblastic ancmia

in Lhtman MA Kipp, TJ. Sdiypohn U (ads): Williams lfemtoloy, 8th o. Nw York,
MeCitaw-fHt, 2010, Figure 41-12A

a. Iron deficiency
b. Vitamin B, deficiency
c. Folic acid deficiency
d. Vitamin B, deficiency
7. 56-7. All EXCEPT which of the following
statements regarding autoimmune hemolytic
anemia in pregnancyare true?
1.Pregnancy can accelerate hemolysis.
2.The direct Coombs test is usually
positive.
 3.The indirect Coombs test isusually
positive.
4.The cause of aberrant antibody
production originates from fetal
microchimerism.

8. 56-8. Pregnant women with paroxysmal

nocturnal hemoglobinuria are at increased
risk for which of the following?
a. Renal failure
b. Venous thrombosis

c. Maternal mortality
d. All of the above
9. 56-9. What is the typical inheritance
pattern of the mutation in the spectrin gene
thatresults in hereditary spherocytosis?
a. Mitochondrial
b. X-linked dominant

c. Autosomal dominant

d. Autosomalrecessive
 mutation?
the true Increased
56-11. serum d. c. serum
b.Low a.
2.Some
degree
1.Infections Increased
Elevated 10.
conferred.hemolysis. glucose-6-
regarding spherocytosis? the
helps scanning 56-10.
appearance,
identifying
Which appearance
serum
confirm
phosphate haptoglobin
in women erythrocyte level electron The
of erythrocytes
pregnancy
of the the
what following
levelbilirubin of
protection following otherspherocytes
who diagnosismicroscopy.
dehydrogenase of
osmotic
can are fibrin level laboratory with image
against statements
precipitateheterozygous of this
split
fragility using
In
hereditary demonstrates
malaria products findingaddition
is
for to
is
25% d. 8%
c. 4% States?
b. 1%
a. among Placentald. Stillbirth
56-13. abruption polycythemia
a.vera? 56-12.
complications
c.
Coagulopathy
Placenta b. 4.All
3.Lyonization
activity.
enzyme
African-AmericanWhat Which of
previa the
is has
the ofabove results
prevalence been the
following
associated in
women a
variable
of pregnancy
in
sickle-cell with
the degree
United
trait of
 Reproduced
condition?whichchest
cough, 56-15. d. c. b. a. under cells
dhone
cell uith
56-14.
Administration
Dietary Low
Hyperglycemia permion
Ih

ad
Nw
fom
Sark
Longo
radiograph disease
of and MoGrHL
which may
DL: In
Ais
r ofbentology assume
2012, patients
the 22-year-old AproteinOxygen
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increasing of
following presents cel7-12 md
nlyis

tension of
the
is paiph
of
deficiency following the with
obtained. with certain
following
ardyspnea.
e primigravida sickle-cell
precipitantscomplaints antibiotics
All conditions?
EXCEPT The configuration
disease,red
following of with
of fever,
this sickle
 Marrow
emboliAtelectasis
d. Infection
Coagulopathy c. b. a.
d.
increased.decreased. 17.56-17. 16.
a.
anemia?
with
c. sickle-cell
b. red isCardiomyopathy anemia
Risk hypertension
Pulmonary b.
complications?
following
maternal
Renal a.
d. c.failure 56-16.
RateGestation accurate
Perinatal cell All
of of transfusions Which of are
fetal-growth
red the Pregnant
mortality
duration regarding at
cell
above increased
of
alloimmunization the women
is for the
rate following
restrictionincreased. pregnant
use risk
is with
decreased. of for
prophylactic
statements which
sickle-cell
is women

is of
the
 minor?
consistent
hemoglobin56-21. a. with 56-20.
globin Gestational
diabetes
d. C.following?
abruption
Placental been
b. a. theof Intrauterine 56-18.
56-19. C.device
sterilization
d.Surgical a. choices
b. women
aa/-- UrinaryPreeclampsia Combination
oral Depot
homozygous associated
Which genotypes
b. Women with mayWhich
with a-/aa
Sickle-cell
medroxyprogesterone
electrophoresis tract sickle-cell help
a of C. with with of
diagnosis the a-/a- aare infections prevent the
-thalassemia? which at an
contraceptive
trait pills
following following
d.ca/aa risk increased
(hemoglobin disease?
of
painful
would to of
ß have the
-thalassemiafindings risk acetate contraceptive
crises
be following
offspring whichfor AS)
most in
on has
a
 Azathioprine
Laparoscopic
splenectomy
corticosteroids
Systemic a. 56-23.
d. c. b.treatment a. 56-22.
thrombocytopenia
d. c.pregnancy?
the coagulopathy
Consumptive b. in
Intravenous
anti-D following Immune
thrombocytopenia
Gestational Severe 4.Hemoglobin 2.Hemoglobin
3.Hemoglobin
hemoglobin
hemoglobin fetal
level 1.Hemoglobin
hemoglobin
hemoglobinlevel
When What
of
thrombocytopenic
immune purpurapreeclampsia
is
indicated is
the the
greater A2 greater A2 A2 A2
most most
thrombocytopenic
immunoglobulin G greater greater less less
appropriate in than than than than
pregnancy, common

2%than than 2% 1%; 1%;

cause 3.5%; fetal normal
3.5%;
initialwhich
purpura? of normal
fetal fetal
of
 26 25.56-25. 24.56-24.
EXCEPTentities
thrombocytopenic clinical
56-26.Autoimmune
hemolyticthrombocytosis conditions C.
deficiency
Iron
Malignancyb. a.
million/uL
conditions?
following which d.
Cordocentesis
Cesarean
delivery C. a. who
1.HUS Essential d. sampling
Scalp b. detect
thrombocytopenicmanagement
None
have
can overlap the fetal
haswhich Although Most of Which
be
uremic platelet
are the
chronic
distinguished
thrombocytopenia
strategies
more between caused cases above
of of
renal syndrome
the purpura there count immune
purpura? the
following? by of
thrombocytosis following
dysfunction. thrombotic is exceeds is
considerable which
(TTP) recommended
by
(HUS),
all of 1 in
and the women
these
in
to
 28. 27.
thrombocytopenia
Moderate
d. hemolysis
Severe
C. b.findings
a.favors Platelet
thrombocytopenic
severe 56-28. transfusion
TTP? conditions
important. c. purpura?
Anticoagulation 56-27.
treatment
a.thromboticfor
coagulation Mild thrombocytopenic d.
Plasmapheresis b. 4.All 3.TTP2.HUS
Marked Intravenous aberrations.
neurologic
disseminated preeclampsia Because What statements more is
transaminase Which is seen
very is
immunoglobulin the
frequently
ofdifferent, the are
primarily
purpura cornerstone
intravascular the fromtreatment true.
elevation following
thrombotic has
(TTP)
differentiating in
of
associatedadults.
of
the(IVIG)
clinical is
two
 Willebrand 56-31. ofepisiotomy
Avoiding
Desmopressin
Uterotonics a. 56-30. risk a.
C.fashion? 56-29.
deficiency
4.Decreased 2.Decreased
3.Increased
1.Increased the d. c. b. reduced
levels
factor levels
factor Operative Autosomal
X-linked
for
following
Pregnancy excessive
by In
women Hemophiliain
factor all dominant
factor factorfactor factor vaginal EXCEPT dominant factor
changes
(vWF)
physiology hemorrhage affected
VIII VII, A,
VII VIII VIll delivery b.
to d. characterized
X-linked
levels; levels; levels? which is
and and factor Autosomal
by inherited
vWF results hemophilia at
decreased vWF of
delivery
increased VIII the recessive
levels in by
levels and in following? recessive
which can A,
what a
vWF vWF von seve
bethe
 gestation?
a. 56-3. Preterm
d. birth c. Stillbirth
Preeclampsia a.
b.pregnancy?
anemia56-2.
in pregnancy? a. 56-1.
500 What generally
All Hematological 9.5
restriction
DisordersFetal-growth d.
hemorrhage
Postpartum encountered
birtha.Willebrand
pregnancy-related
complications
c.Preterm
abruption
Placental b. 56-32.
mg What of Which gldL
b. th e
800 isabove b.
the of 10.hemoglobin
0
mgmaternal the Although
c. following g/dL good
1000 c. value
disease,
in
iron 10.5 up in
mg
requirement
adverse g/dL is women
d. used to pregnancy
1200
pregnancy d. to 50which
mg 11.0 define
percent
in g/dL
pregnancy anemia ofwho
outcomes
outcomes
the have
in of
for the following
is such may be
a associated trimester
secondof von
typical
cases? are
singleton with
 d. C. b. a.complete
she 56-5.for laboratory
volume 56-4.
performed,
perta
dad c
d. C. b. a.
AnAn A AnemiaAcute
Anemia
Iron-deficiency
anemia
7. 6. increase An 20% iswhich
increaseelevated compliant
blood
of beginning
revealsdiabetes56-7. clinical
status?
hemoglobinher feeling
pressure delívery56-6. Your A
action well rise of
22-year-old
blood you resulting blood of
except 4. 3. 2. 1. patient chronic Tna assessment
81
pressure in in inrecommend which
well loss (1.
r a and You Transfusion
Three Areticulocyte her withcount fL.
fohematocrit All Repeat is with the red Rahandn
of 36-year-old
for of 100/60 cell is from anemia
this pregnancy isare is and corpuscular volume
mean hematocrit disease Dl. is As
128/78 the stable a one
taking diagnosed
mild currentlycaring months a width Chang
patient? abovecomplete denies2-liter distribution folate SY.
shown. a Gl
reveals
week
ferrous t
part
mmHg, her dl presents
leda
fatigue, of of atestimatedG3P3 count
mmHg, 19% was for 7.2 deficiency
28 a
of units 2 dizziness iron?after with What theof
iron
blood g/dL. her is sulfate a
weeks
1.5
and with29-year-old starting severe hemoglobin
and her mg/dl. supplementation of postoperative
pulse blood work-up is to
a countblood Which or supplementation times
three the your
temperaturevitals pregnant.
ferritin palpitations is iron-deficiency
iron most
Her G1 emergently of 92 loss for office
are of e
thbeats due day therapy,
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as150 Her following
likely her of&
suffers
at
36.8°C.
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trimester
ng/m. at lysis
follow-ing
discharge minute, what anemia diagnosis? weeks
from ambulating. of with
Whatpulse would would
She
creatinine adhesions. a a
complete and a at peripheral
islong-standing
reports
82 you repeat youdaily. 34 gestation.
mean
the her
beats advise Her weeks'
best at postpartum She expect If corpuscular
overallblood the bloodcesarean you
next per based reports gestation, smear Routine
type repeatto
minute, see
course feelingcount
1 on if a is