CCRN Hematology and Immunology 2 — Questions and Answers
Question 1: A patient with disseminated intravascular coagulation (DIC) would be expected to have which laboratory profile?
- Low platelets, high D-dimer, prolonged PT/PTT, low fibrinogen (Correct answer)
- High platelets, low D-dimer, normal PT/PTT, high fibrinogen
- Normal platelets, low D-dimer, short PT/PTT, high fibrinogen
- Low platelets, low D-dimer, normal PT, high fibrinogen
Correct answer: Low platelets, high D-dimer, prolonged PT/PTT, low fibrinogen
DIC consumes platelets and clotting factors and generates fibrin degradation products, producing thrombocytopenia, elevated D-dimer, prolonged PT/PTT, and low fibrinogen.
Question 2: Which transfusion reaction is most life-threatening and typically results from ABO incompatibility?
- Acute hemolytic reaction (Correct answer)
- Febrile non-hemolytic reaction
- Mild allergic (urticarial) reaction
- Delayed hemolytic reaction
Correct answer: Acute hemolytic reaction
Acute hemolytic transfusion reactions from ABO incompatibility cause intravascular hemolysis, shock, and renal failure and require immediate cessation of the transfusion.
Question 3: A patient receiving heparin develops a platelet count drop of more than 50% on day 6. What condition should be suspected?
- Heparin-induced thrombocytopenia (HIT) (Correct answer)
- Idiopathic thrombocytopenic purpura
- Aplastic anemia
- Vitamin K deficiency
Correct answer: Heparin-induced thrombocytopenia (HIT)
HIT is an immune-mediated reaction occurring 5-10 days after heparin exposure, causing thrombocytopenia and a paradoxical thrombosis risk.
Question 4: Which finding best indicates a neutropenic patient is at highest infection risk?
- Absolute neutrophil count below 500/mm3 (Correct answer)
- White blood cell count of 8,000/mm3
- Hemoglobin of 10 g/dL
- Platelet count of 90,000/mm3
Correct answer: Absolute neutrophil count below 500/mm3
An ANC below 500/mm3 defines severe neutropenia and markedly increases the risk of serious infection.
Question 5: What is the priority intervention for a neutropenic patient who develops a fever of 38.5C?
- Obtain cultures and start broad-spectrum antibiotics promptly (Correct answer)
- Administer acetaminophen and recheck in 4 hours
- Hold all antibiotics until culture results return
- Place the patient in droplet isolation only
Correct answer: Obtain cultures and start broad-spectrum antibiotics promptly
Neutropenic fever is an emergency requiring blood cultures and empiric broad-spectrum antibiotics within an hour to prevent sepsis.
Question 6: Which clotting factor pathway does the PTT (partial thromboplastin time) primarily evaluate?
- Intrinsic pathway (Correct answer)
- Extrinsic pathway
- Fibrinolytic pathway
- Common platelet pathway
Correct answer: Intrinsic pathway
PTT measures the intrinsic and common pathways and is used to monitor heparin therapy.
Question 7: A patient with sickle cell disease in vaso-occlusive crisis requires which priority interventions?
- Oxygen, hydration, and pain management (Correct answer)
- Fluid restriction and cold compresses
- Diuretics and platelet transfusion
- Vitamin K and bed rest only
Correct answer: Oxygen, hydration, and pain management
Vaso-occlusive crisis is managed with oxygenation, aggressive hydration, and adequate analgesia to relieve sickling and ischemic pain.
CCRN Hematology and Immunology 2
A patient with disseminated intravascular coagulation (DIC) would be expected to have which laboratory profile?