Chapter 18 Hematologic Disorders

1. A 32-week, small-for-gestational-age infant is born via primary cesarean section due to a nonreassuring fetal heart tracing. In addition to sending blood samples for TORCH (toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex) titers, the physician requests that immunoglobulin levels be determined. In the event of an in utero viral infection, which immunoglobulin level would be elevated in the period immediately after birth?

A. Immunoglobulin G

B. Immunoglobulin M

C. Immunoglobulin A

D. Immunoglobulin E

2. A 26-year-old primigravida was found to have pregnancy-induced hypertension at 22 weeks’ gestation. After her infant was born at term, the infant was found to have a venous hematocrit of 68%. What is the most likely reason for the polycythemia experienced by this infant?

A. The infant has a higher level of erythropoietin in his body.

B. The infant has been exposed to a maternal-fetal hemorrhage in utero.

C. The infant has a higher percentage of hemoglobin F, which results in a higher hematocrit.

D. The obstetrician stripped blood from the umbilical cord into the infant at the time of delivery.

3. Which of the following infants will show the greatest affinity for oxygen?

A. A 28-week gestational age infant with a temperature of 36.5° C (97.8° F)

B. A 30-week gestational age infant with a Paco₂ of 55

C. A 35-week gestational age infant with a temperature of 38.0° C (100.4° F)

D. A 38-week gestational age infant with a Paco₂ of 40

4. Compared with adult red blood cells, newborn red blood cells:

A. are more resilient.

B. have a longer life span.

C. have a decreased mean corpuscular volume.

D. carry a larger amount of oxygen on the hemoglobin.

5. A 35-week gestational age infant was born in septic shock 36 hours ago. Cultures of blood specimens taken at birth grew out positive for Escherichia coli. The infant has been receiving mechanical ventilation since birth and has required dopamine (14 mcg/kg/minute) and dobutamine (5 mcg/kg/minute). A short while ago, the infant had a sudden pulmonary hemorrhage. Furthermore, he now has petechiae on his trunk. An examination of the maternal laboratory results shows that the platelet count is normal. Based on the history and clinical presentation of this infant, what disease process is occurring?

A. Neonatal alloimmune thrombocytopenia

B. Maternal systemic lupus erythematosus

C. Disseminated intravascular coagulation

D. Maternal idiopathic thrombocytopenic purpura

6. What are the expected laboratory results for a patient with disseminated intravascular coagulation?

A. Normal platelet count, prolonged prothrombin time (PT), and prolonged partial thromboplastin time (PTT)

B. Low platelet count, low fibrinogen level, and D-Dimer+

C. Low platelet count, prolonged PT, and shortened PTT

D. Normal platelet count, low fibrinogen level, and elevated level of fibrin split products

7. What blood transfusion product will most directly supply fibrinogen to an infant?

A. Platelets

B. Cryoprecipitate

C. Fresh frozen plasma

D. Packed red blood cells

Questions 8 and 9 refer to the following scenario: A 32-week gestational age, 1700-g infant has an umbilical arterial line in place. Fifteen minutes after a radiograph of the infant is taken, the nurse notices a large pool of blood on the bed next to the infant. The estimated blood loss is 45 ml.

8. Which set of signs and symptoms is most likely to reflect the infant’s condition in the first 30 to 60 minutes following this acute loss of blood?

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