Assessment: Hematologic System Quiz

a, b, e. Although all of the listed nutrients are helpful, iron, folic acid, and cobalamin (vitamin B12) are essential for erythropoiesis.

c. Increased reticulocytes, or immature red blood cells (RBCs), indicate an increased rate of erythropoiesis or stimulation of erythrocyte (RBC) production by the bone marrow. Basophils are stimulated by granulocyte colony-stimulating factor in response to an antigen or by tissue injury. Monocytes and lymphocytes respond to tissue injury, including infection

b. During fibrinolysis by plasmin, the fibrin clot is split into smaller molecules known as FSPs or FDPs. Increased FSPs impair platelet aggregation, reduce prothrombin, prevent fibrin stabilization, and lead to bleeding.

b. A smooth, shiny, reddened tongue is an indication of iron deficiency anemia or pernicious anemia that would be reflected by a decreased hemoglobin level. The decreased neutrophils would be indicative of neutropenia. The increased WBC count could be indicative of an infection and the increased RBC count of polycythemia.

a, b, d. The myeloblast is a committed hematopoietic cell found in the bone marrow from which granulocytes develop. A disorder in which myeloblasts are overproduced would result in increased basophils, eosinophils, and neutrophils.

b. A patient with type O Rh + blood has no A or B antigens on the RBC but does have anti-A and anti-B antibodies in the blood and has an Rh antigen. Type AB Rh − blood has both A and B antigens on the RBC but no Rh antigen and no anti-A or anti-B antibodies. If the type AB Rh−blood is given to the patient with type O Rh + blood, the antibodies in the patient’s blood will react with the antigens in the donor blood, causing hemolysis of the donor cells. There will be no Rh reaction because the donor blood has no Rh antigen

a, b, e. The abdominal organs that are primarily involved in hematologic function are the liver, spleen, and lymph nodes. The liver filters the blood, produces procoagulants, and stores iron. The spleen’s functions are hematopoietic (RBCs produced during fetal development);
filtration (removes old and defective erythrocytes, iron for reuse, and bacteria); immunologic (supplies lymphocytes, monocytes, and stored immunoglobulins); and storage (RBCs and platelets). The lymph nodes filter pathogens and foreign particles from lymphatic circulation.

a, b, c, f. These characteristics are evident with neutrophils. Platelets arise from megakaryocytes and are stored in the spleen. Eosinophils are increased in individuals with allergies and make up 2% to 4% of white blood cells (WBCs).

c. Pancytopenia is decreased RBCs, WBCs, and platelets. Hemolysis is RBC destruction. Leukopenia is WBC < 5000/μL. Thrombocytosis is increased platelets, and thrombocytopenia is decreased platelets.

b. Petechiae are small, flat, red, or reddish-brown pinpoint microhemorrhages that occur on the skin when platelet levels are low. When petechiae are numerous, they group, causing reddish bruises known as purpura. Sternal tenderness is associated with leukemias. Jaundice
occurs when anemias are of a hemolytic origin, resulting in accumulation of bile pigments from RBCs. Enlarged, tender lymph nodes are associated with infection or cancer.

d. Lymph node biopsy is usually done to determine whether malignant cells are present in lymph nodes and can be used to diagnose lymphomas as well as metastatic spread from any malignant tumor in the body. Leukemias may infiltrate lymph nodes, but biopsy of the nodes is more commonly used to detect any type of neoplastic cells.

b, c. Bone marrow and lymph node biopsies are preferred methods to obtain the sample for gene analysis. If a large number of abnormal cells are circulating in the blood, peripheral blood may be used. The other options will not provide the desired information.

c. Any platelet count < 150,000/μL is considered thrombocytopenia and could place the patient at risk for bleeding, necessitating special consideration in nursing care. Chemotherapy may cause bone marrow suppression and a depletion of all blood cells. The other factors are all within normal range.

c. The aspiration of bone marrow content is done with local anesthesia at the site of the puncture, but the aspiration causes a suction pain that is quite painful but very brief. There is generally only residual soreness following the test.

a. The parietal cells of the stomach secrete intrinsic factor, a substance necessary for the absorption of cobalamin (vitamin B12), and if all or part of the stomach is removed, the lack of intrinsic factor can lead to impaired RBC production and pernicious anemia. Recurring infections indicate decreased WBCs and immune response, and corticosteroid therapy may cause a neutrophilia and lymphopenia. Oral contraceptive use is strongly associated with changes in blood coagulation.

c. As a person ages the partial thromboplastin time (PTT) is normally decreased, so an abnormally high PTT of 60 seconds is an indication that bleeding could readily occur. Platelets are unaffected by aging and 150,000/μL is a normal count. Serum iron levels are decreased and the erythrocyte sedimentation rate (ESR) is significantly increased with aging, as are reflected in these values.

d. Protein C and protein S are examples of anticoagulants that are involved in clot retraction and dissolution. Fibrinolysis also keeps blood in its fluid form by thrombin-activating conversion of plasminogen to plasmin. Plasmin attacks fibrin or fibrinogen and splits it into smaller elements known as fibrin split products (FSPs) or fibrin degradation products (FDPs).

a, c, d. Basophils, eosinophils, and neutrophils are the granulocytic leukocytes. Lymphocytes are the agranular leukocytes that form the basis of the cellular and humoral immune responses. Monocytes are agranulocytes that are potent phagocytic cells. Thrombocytes are not granulocytes or agranulocytes, and they initiate the clotting process.

a. Superficial lymph nodes are evaluated by light palpation, but they are not normally palpable. It may be normal to find small (< 1.0 cm), mobile, firm, nontender nodes. Deep lymph nodes are detected radiographically.

a. A contrast CT scan involves the use of an iodine-based dye that could cause a reaction if the patient is sensitive to iodine. Metal implants or internal appliances and claustrophobia should be determined before MRI. Prior blood transfusions are not a factor in this diagnostic test.

a. Lymphedema is the obstruction of lymph flow that results in accumulation of lymph fluid for the patient in the right arm following a right-sided breast mastectomy. The other options are not hematologic problems that would cause extreme swelling.