Chapter 30: Alterations of Hematologic Function in Children
MULTIPLE CHOICE
1. What is the cause of polycythemia in the fetus?
a. Fetal hemoglobin has a greater affinity for oxygen as a result of diphosphoglycerate
(DPG).
b. The fetus has a different hemoglobin structure of two - and two -chains rather
than two -and two -chains.
c. Increased erythropoiesis occurs in response to the hypoxic intrauterine
environment.
d. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to
the pulmonary capillaries.
2. Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin?
a. The fetus does not have its own oxygen supply and must rely on oxygen from the
maternal vascular system.
b. The fetus has two -chains on the hemoglobin, rather than two -chains as in the
adult.
c. Fetal hemoglobin interacts less readily with diphosphoglycerate (DPG), which
inhibits hemoglobin-oxygen binding.
3. Which blood cell type is elevated at birth but decreases to adult levels during the first year of
life?
a. Monocytes c. Neutrophils
b. Platelets d. Lymphocytes
4. In a full-term infant, the normal erythrocyte life span is _____ days, whereas the adult
erythrocyte life span is _____ days.
a. 30 to 50; 80 c. 90 to 110; 140
b. 60 to 80; 120 d. 120 to 130; 150
5. What is the most common cause of insufficient erythropoiesis in children?
a. Folic acid deficiency c. Hemoglobin abnormality
b. Iron deficiency d. Erythrocyte abnormality
6. How does hemolytic disease of the newborn (HDN) cause acquired congenital hemolytic
anemia?
a. HDN develops when hypoxia or dehydration causes the erythrocytes to change
shapes, which are then recognized as foreign and removed from circulation.
b. HDN is an alloimmune disease in which the mother’s immune system produces
antibodies against fetal erythrocytes, which are recognized as foreign and removed
from circulation.
c. HDN develops when the polycythemia present in fetal life continues after birth,
causing the excessive number of erythrocytes to be removed from circulation.
d. HDN is an autoimmune disease in which the fetus’s immune system produces
, antibodies against fetal erythrocytes, which are recognized as foreign and removed
from circulation.
7. Erythroblastosis fetalis is defined as an:
a. Allergic disease in which maternal blood and fetal blood are antigenically
incompatible
b. Alloimmune disease in which maternal blood and fetal blood are antigenically
incompatible
c. Autoimmune disease in immature nucleated cells that are released into the
bloodstream
d. Autosomal dominant hereditary disease
8. An infant’s hemoglobin must fall below ___ g/dl before signs of pallor, tachycardia, and
systolic murmurs occur.
a. 11 c. 7
b. 9 d. 5
9. Which vitamin improves the absorption of oral iron taken to treat iron deficiency anemia in
children?
a. A c. C
b. B d. E
10. Hemolytic disease of the newborn (HDN) can occur if the mother:
a. Is Rh-positive and the fetus is Rh-negative
b. Is Rh-negative and the fetus is Rh-positive
c. Has type A blood and the fetus has type O
d. Has type AB blood and the fetus has type B
11. When diagnosed with hemolytic disease of the newborn (HDN), why does the newborn
develop hyperbilirubinemia after birth but not in utero?
a. Excretion of unconjugated bilirubin through the placenta into the mother’s
circulation is no longer possible.
b. Hemoglobin does not break down into bilirubin in the intrauterine environment.
c. The liver of the fetus is too immature to conjugate bilirubin from a lipid-soluble to
water-soluble form.
d. The destruction of erythrocytes producing bilirubin is greater after birth.
12. Fetuses who do not survive anemia in utero are usually stillborn with gross edema of the
entire body. Which term is used to identify this condition?
a. Spherocytosis c. Erythroblastosis fetalis
b. Icterus gravis neonatorum d. Hydrops fetalis
13. What is the name of the disorder in which levels of bilirubin remain excessively high in the
newborn and are deposited in the brain?
a. Kernicterus c. Jaundice
b. Icterus neonatorum d. Icterus gravis neonatorum
, 14. What treatment prevents the development of kernicterus in an infant born with hemolytic
disease of the newborn (HDN)?
a. Administration of intravenous fluids to dilute the blood
b. Replacement transfusion of new Rh-positive blood that is not contaminated with
anti-Rh antibodies
c. Performance of a splenectomy to prevent the destruction of abnormal erythrocytes
d. Replacement transfusion of Rh-negative erythrocytes
15. Glucose 6-phosphate dehydrogenase (G6PD) deficiency is what type of inherited disorder?
a. X-linked dominant c. Autosomal dominant
b. X-linked recessive d. Autosomal recessive
16. Sickle cell disease is classified as a(an):
a. Inherited X-linked recessive disorder
b. Inherited autosomal recessive disorder
c. Disorder initiated by hypoxemia and acidosis
d. Disorder that is diagnosed equally in men and women
17. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process?
a. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes
hemoglobin A (HbA) to HbS.
b. Genetic mutation in which two amino acids (histidine and leucine) are missing.
c. Genetic mutation in which one amino acid (valine) is replaced by another
(glutamic acid).
d. Autoimmune response in which one amino acid (proline) is detected as an antigen
by abnormal immunoglobulin G (IgG).
18. Sickle cell disease (SCD) is what type of inherited disorder?
a. Autosomal dominant c. X-linked dominant
b. Autosomal recessive d. X-linked recessive
19. What is the reason most children diagnosed with sickle cell anemia are not candidates for
either bone marrow or stem cell transplants?
a. Well-matched stem cell donors are difficult to find.
b. The child is usually too weak to survive the procedure.
c. The child’s immune system will not appropriately respond to the antirejection
medications.
d. Although effective for adults, neither procedure has been proven effective for
children.
20. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in
infants?
a. Atelectasis and pneumonia
b. Edema of the hands and feet
MULTIPLE CHOICE
1. What is the cause of polycythemia in the fetus?
a. Fetal hemoglobin has a greater affinity for oxygen as a result of diphosphoglycerate
(DPG).
b. The fetus has a different hemoglobin structure of two - and two -chains rather
than two -and two -chains.
c. Increased erythropoiesis occurs in response to the hypoxic intrauterine
environment.
d. The lungs of the fetus are undeveloped and unable to diffuse oxygen adequately to
the pulmonary capillaries.
2. Why does fetal hemoglobin have a greater affinity for oxygen than adult hemoglobin?
a. The fetus does not have its own oxygen supply and must rely on oxygen from the
maternal vascular system.
b. The fetus has two -chains on the hemoglobin, rather than two -chains as in the
adult.
c. Fetal hemoglobin interacts less readily with diphosphoglycerate (DPG), which
inhibits hemoglobin-oxygen binding.
3. Which blood cell type is elevated at birth but decreases to adult levels during the first year of
life?
a. Monocytes c. Neutrophils
b. Platelets d. Lymphocytes
4. In a full-term infant, the normal erythrocyte life span is _____ days, whereas the adult
erythrocyte life span is _____ days.
a. 30 to 50; 80 c. 90 to 110; 140
b. 60 to 80; 120 d. 120 to 130; 150
5. What is the most common cause of insufficient erythropoiesis in children?
a. Folic acid deficiency c. Hemoglobin abnormality
b. Iron deficiency d. Erythrocyte abnormality
6. How does hemolytic disease of the newborn (HDN) cause acquired congenital hemolytic
anemia?
a. HDN develops when hypoxia or dehydration causes the erythrocytes to change
shapes, which are then recognized as foreign and removed from circulation.
b. HDN is an alloimmune disease in which the mother’s immune system produces
antibodies against fetal erythrocytes, which are recognized as foreign and removed
from circulation.
c. HDN develops when the polycythemia present in fetal life continues after birth,
causing the excessive number of erythrocytes to be removed from circulation.
d. HDN is an autoimmune disease in which the fetus’s immune system produces
, antibodies against fetal erythrocytes, which are recognized as foreign and removed
from circulation.
7. Erythroblastosis fetalis is defined as an:
a. Allergic disease in which maternal blood and fetal blood are antigenically
incompatible
b. Alloimmune disease in which maternal blood and fetal blood are antigenically
incompatible
c. Autoimmune disease in immature nucleated cells that are released into the
bloodstream
d. Autosomal dominant hereditary disease
8. An infant’s hemoglobin must fall below ___ g/dl before signs of pallor, tachycardia, and
systolic murmurs occur.
a. 11 c. 7
b. 9 d. 5
9. Which vitamin improves the absorption of oral iron taken to treat iron deficiency anemia in
children?
a. A c. C
b. B d. E
10. Hemolytic disease of the newborn (HDN) can occur if the mother:
a. Is Rh-positive and the fetus is Rh-negative
b. Is Rh-negative and the fetus is Rh-positive
c. Has type A blood and the fetus has type O
d. Has type AB blood and the fetus has type B
11. When diagnosed with hemolytic disease of the newborn (HDN), why does the newborn
develop hyperbilirubinemia after birth but not in utero?
a. Excretion of unconjugated bilirubin through the placenta into the mother’s
circulation is no longer possible.
b. Hemoglobin does not break down into bilirubin in the intrauterine environment.
c. The liver of the fetus is too immature to conjugate bilirubin from a lipid-soluble to
water-soluble form.
d. The destruction of erythrocytes producing bilirubin is greater after birth.
12. Fetuses who do not survive anemia in utero are usually stillborn with gross edema of the
entire body. Which term is used to identify this condition?
a. Spherocytosis c. Erythroblastosis fetalis
b. Icterus gravis neonatorum d. Hydrops fetalis
13. What is the name of the disorder in which levels of bilirubin remain excessively high in the
newborn and are deposited in the brain?
a. Kernicterus c. Jaundice
b. Icterus neonatorum d. Icterus gravis neonatorum
, 14. What treatment prevents the development of kernicterus in an infant born with hemolytic
disease of the newborn (HDN)?
a. Administration of intravenous fluids to dilute the blood
b. Replacement transfusion of new Rh-positive blood that is not contaminated with
anti-Rh antibodies
c. Performance of a splenectomy to prevent the destruction of abnormal erythrocytes
d. Replacement transfusion of Rh-negative erythrocytes
15. Glucose 6-phosphate dehydrogenase (G6PD) deficiency is what type of inherited disorder?
a. X-linked dominant c. Autosomal dominant
b. X-linked recessive d. Autosomal recessive
16. Sickle cell disease is classified as a(an):
a. Inherited X-linked recessive disorder
b. Inherited autosomal recessive disorder
c. Disorder initiated by hypoxemia and acidosis
d. Disorder that is diagnosed equally in men and women
17. Hemoglobin S (HbS) is formed in sickle cell disease as a result of which process?
a. Deficiency in glucose 6-phosphate dehydrogenase (G6PD) that changes
hemoglobin A (HbA) to HbS.
b. Genetic mutation in which two amino acids (histidine and leucine) are missing.
c. Genetic mutation in which one amino acid (valine) is replaced by another
(glutamic acid).
d. Autoimmune response in which one amino acid (proline) is detected as an antigen
by abnormal immunoglobulin G (IgG).
18. Sickle cell disease (SCD) is what type of inherited disorder?
a. Autosomal dominant c. X-linked dominant
b. Autosomal recessive d. X-linked recessive
19. What is the reason most children diagnosed with sickle cell anemia are not candidates for
either bone marrow or stem cell transplants?
a. Well-matched stem cell donors are difficult to find.
b. The child is usually too weak to survive the procedure.
c. The child’s immune system will not appropriately respond to the antirejection
medications.
d. Although effective for adults, neither procedure has been proven effective for
children.
20. Which manifestations of vasoocclusive crisis are associated with sickle cell disease (SCD) in
infants?
a. Atelectasis and pneumonia
b. Edema of the hands and feet
