Hematology

1. 6-year-old girl is brought into the emergency room after an automobile accident Physical examination
shows bleeding from multiple wounds, and a CBC reveals a normocytic, normochromic anemia. Which
of the following indices is most helpful in defining this patient's anemia as normocytic ?

A. Hematocrit

B. Hemoglobin

C. Mean corpuscular hemoglobin concentration

D. Mean corpuscular volume

E. Red blood cell count

2. A 60-year-old man presents with a 6-month history of increasing fatigue. Physical examination
reveals marked pallor, and a CBC shows a macrocytic anemia. Which oft following is the most likely
cause of anemia in this patient ?

A Alcoholism

B. Chronic disease

c. Tron deficiency

D. Renal disease E Thalassemia

3. A 30-year-old woman complains of recent easy fatigability, bruising, and recurrent throat infections.
Physical examination reveals numerous petechiae over her body and mouth . Abnormal laboratory
findings include hemoglobin of 6 g/dL, WBC of 1,500/mL, and platelets of 20,000/ml. The bone marrow
is hypocellular and displays increased fat What is the appropriate diagnosis ?

A Aplastic anemia Page

B iron - deficiency

c .Megaloblastic anemia

4. A 20-year-old thin fashion model complains that she cannot concentrate and is alwa tired. She has
heavy menstrual bleeding every month but is otherwise healthy . The peripheral blood smear is shown
in the image . Which of the following laboratory findings would be expected in this patient ?

A. Hyperbilirubinemia

B. Increased serum ferritin

C. Low plasma iron saturation

D. Positive direct Coombs test

E. Vitamin B12 deficiency

5. A 10-year-old boy presents with chronic fatigue. Physical examination reveals slight jaundice and
splenomegaly . The results of laboratory studies include hemoglobin of g/dL, hematocrit of 32%, total
bilirubin of 2.6 mg/dl, and conjugated bilirubin of 0.8 mg/dL. The peripheral blood smear is shown in
the image . The osmotic fragility of the patient's RBCs is increased, but the Coombs test is negative.
Defects in which of the following are involved in the pathogenesis of this disorder ?

A. DNA synthesis

B. Erythrocyte cytoskeleton

C. Erythrocyte maturation

D. Glucose - 6 - phosphate dehydrogenase ( G6PD )

E Hemoglobin synthesis

6. A 10 - month - old boy of Arabic extraction is brought to the physician by his parents wh complain that
their child is failing to thrive. Physical examination reveals splenomegal and jaundice . A CBC shows a
microcytic , hypochromic anemia ( hemoglobin = 7.4 g/dL Fetal hemoglobin accounts for most of the
hemoglobin . A peripheral blood smear is shown in the image . Which of the following is the appropriate
diagnosis ?

A G6PD deficiency

B. Hereditary elliptocytosis

C. Hereditary spherocytosis

D. Iron deficiency anemia

E. B – Thalassemia

7. A 45-year-old chronic alcoholic man presents with mental confusion. The peripheral blood smear is
shown in the image . The morphologic abnormalities demonstrated in blood smear are most likely
associated with which the following conditions ?

A. Abnormal spectrin in red cell membranes

B. Chronic liver disease

C. Chronic renal failure

D. Microthrombi in capillaries E. Vitamin B12 deficiency

8. A patient with a history of chronic alcoholism presents with a macrocytic anemia and
thrombocytopenia. Blood smear examination demonstrates numerous oval macrocyt and
hypersegmented neutrophils ( results shown in the image ) . A Schilling test is norm which of the
following is the most likely diagnosis ?

A. Anemia of chronic disease

B. Folic acid deficiency

C. G6PD deficiency

D. tron deficiency anemia

E Sickle cell anemia

9. A 23-year-old, previously healthy man of Italian origin develops moderate to severe hemolytic anemia
. The previous evening he had celebrated a Saint's day with a feast beans and pasta . Urinalysis shows
free hemoglobin, and the direct Coombs test is negative. Supravital staining of the blood smear
demonstrates numerous membrane bound inclusions ( Heinz bodies ) within erythrocytes . Which of
the following is the mos likely diagnosis ?

A G6PD deficiency

B. Paroxysmal nocturnal hemoglobinuria

C. Sickle cell anemia

D. B - Thalassemia minor

E. Warm antibody autoimmune hemolytic anemia

10. A 60-year-old man complains of night sweats, weight loss, easy fatigability, and discomfort in the left
upper abdominal quadrant. Physical examination reveals splenomegaly . Laboratory studies show
leukocytosis ( 40,000 / mL ) . A peripheral blood smear demonstrates mature and maturing
granulocytes , myelocytes , basophils , and occasional myeloblasts . The bone marrow is hypercellular
and dominated by WBC precursors . Megakaryocytes are numerous, and RBC precursors are less
prominent. A smear of the bone marrow aspirate is shown in the image . Cytogenetic studies reveal a
monoclonal population of abnormal cells with a t (9:22) (934; q11) chromosomal translocation. What is
the appropriate diagnosis ?

A cute lymphoblastic leukemia

B. Acute myeloid leukemia

C Chronic lymphocytic leukemia

D. Chronic myelogenous leukemia

E Myelodysplastic syndrome

11. A 42-year-old woman presents with an enlarged supraclavicular lymph node . The patient is HIV
positive and takes antiviral medications. A lymph node biopsy is shown in the image . The tumor cells
express B cell antigens and are positive for Epstein - Barr viru (EBV). Which of the following is the most
likely diagnosis ?

A. Follicular lymphoma

B. Hodgkin lymphoma

C. Large B - cell lymphoma

D. MALT lymphoma

E. Mantle cell lymphoma

12. A 58 year old man presents with a 2-month history of erythematous, scaly plaques ove his trunk and
upper extremities. Biopsy of these lesions reveals an atypical lymphocytic infiltrate in the dermis, which
extends into the overlying epidermis. Immunohistochemical staining demonstrates positive staining for
CD4. Which of the following is the most likely diagnosis ?

A. Acute lymphoblastic lymphoma

B Chronic lympho

C extramedullary

D. Hairy cell leukemia

E. Mycosis fungoides

13. A 25-year-old previously healthy woman develops spontaneous vaginal bleeding. The following day,
she experiences a tonic - clonic seizure. On physical examination, she is febrile and jaundiced and has
widespread purpura. Laboratory findings include a hemoglobin of 5.3 g/dL with 8% reticulocytes, a
platelet count of 10,000/ml, and a BL of 48 mg/dl. The peripheral blood smear is shown in the image .
Which of the followin is the appropriate diagnosis ?

A. Drug - induced thrombocytopenia

B. Henoch - Schönlein purpura

C. Idiopathic thrombocytopenic purpura

D. Thrombotic thrombocytopenic purpura

E. von Willebrand disease

14. A 45 year old man suffers severe third - degree burns in an industrial accident . During hospital stay,
the patient develops anemia, thrombocytopenia, and widespread purpu blood oozes from venipuncture
sites. Laboratory studies show that fibrin split product are elevated . The peripheral blood smear is
shown in the image . What is the appropria diagnosis ?

A. Acanthocytosis

B. Henoch - Schönlein purpura

C. Idiopathic thrombocytopenic purpura

D. Microangiopathic hemolytic anemia

E. Paroxysmal nocturnal hemoglobinuria

15. A 4 - year - old boy develops severe bleeding into the knee joint . Laboratory studies shoy that
serum levels of factor IX are reduced, but levels factor VIII are normal. What is the appropriate
diagnosis ?

A. Hemophilia A

B. Hemophilia B

C. Henoch - Schönlein purpura

D. Idiopathic thrombocytopenic purpura

E von Willebrand disease

16. A 39-year-old man reports seeing red-colored urine in the morning. The CBC reveals anemia, low
serum iron, and an elevated reticulocyte count. Laboratory studies show increased lysis of erythrocytes
when incubated with either sucrose or acidified serum. Which of the following is the appropriate
diagnosis?

A. Anemia of chronic renal failure

B. Hereditary spherocytosis

C. Microangiopathic hemolytic anemia

D. Paroxysmal nocturnal hemoglobinuria

E. Vitamin B12 deficiency

17. An 18-year-old man is rushed to the emergency room in shock following a motor vehic accident. He
is transfused with 5 U of blood. Following the transfusion, the patient complains of fever, nausea,
vomiting, and chest pain. Laboratory data show elevated indirect serum bilirubin, decreased serum
haptoglobin, and a positive Coombs test. Which of the following is the most likely diagnosis?

A. Autoimmune hemolytic anemia

B. Disseminated intravascular coagulation

C. Hemolytic transfusion reaction

D. Hemolytic uremic syndrome

E. Microangiopathic hemolysis

18. A 60-year-old woman complains of weakness and hematuria. Physical examination shows marked
pallor, hepatosplenomegaly, and numerous ecchymoses of the upper and lower extremities. A CBC
reveals a normocytic normochromic anemia, thrombocytopenia, neutropenia, and a marked
leukocytosis, which is composed mainly of myeloblasts. The major clinical problems associated with this
patient's condition are most directly related to which of the following?

A. Avascular necrosis of bone

B. Disseminated intravascular coagulation

C. Hypersplenism

D. Microangiopathic hemolytic anemia

E. Suppression of hematopoiesis

19. A 47-year-old man with a history of a heart-lung transplant 3 years ago complains of fever, malaise,
and abdominal pain. The patient has been taking cyclosporine for immunosuppression. Physical
examination reveals an abdominal mass. A CT-guided biopsy of the mass shows atypical lymphocytes
that are positive for latent membrane proteins of Epstein-Barr virus (EBV). What is the most likely
diagnosis?

A. Acute suppurative lymphadenitis

B. Burkitt lymphoma

C. Graft-versus-host disease

D. Infectious mononucleosis

E. Posttransplant lymphoproliferative disorder

20. A 56-year-old man presents with a 2-week history of fatigue. The patient's past medic. history is
significant for aortic and mitral valve replacement 5 months ago. A CBC show moderate anemia with an
increased reticulocyte count. Which of explains the pathogenesis of anemia in this patient? following
best

A. Complement-mediated hemolysis

B. Decreased blood flow

C. Direct red cell trauma

D. Sludging of erythrocytes

E. Thrombin activation

21. A 14-year-old boy has a high fever of 10 days' duration. Physical examination shows a temperature
of 38.3° C; pulse, 100/min; respiratory rate, 28/min; and blood pressure, 80/40 mm Hg. He has scattered
petechial hemorrhages on the trunk and There is no enlargement of liver, spleen, or lymph nodes. The
CBC shows hemoglobin, 13.2 g/dL; hematocrit, 38.9%; MCV, 93 um3; platelet count, 175,000/mm3; and
WBC count, 1850/mm3 with 1% segmented neutrophils, 98% lymphocytes, and 1% monocytes. Which of
the following is the most likely diagnosis? remities.

A. Acute lymphoblastic leukemia

B. Acute myelogenous leukemia

C. Aplastic anemia

D. Idiopathic thrombocytopenic purpura

E. Systemic inflammatory response syndrome

22. A 12-year-old boy has had increasing abdominal distention and pain for the past 3 days Physical
examination of his abdomen shows lower abdominal tenderness with tympany and reduced bowel
sounds. An abdominal CT scan shows a 7-cm mass involving the region of the ileocecal valve. Surgery is
performed and the resected mass microscopically shows sheets of intermediate-sized lymphoid cells,
with nuclei having coarse chromatin, several nucleoli, and many mitotic figures. A bone marrow biopsy
sample is negative for this cell population. Cytogenetic analysis of the cells from the mass shows a
t(8;14) karyotype. Flow cytometric analysis reveals 40% of the cells are in S phase. The tumor shrinks
dramatically after a course of chemotherapy. Which of the following is the most likely diagnosis?

A. Acute lymphoblastic leukemia/lymphoma

B. Burkitt lymphoma

C. Diffuse large B-cell lymphoma

D. Follicular lymphoma

E. Plasmacytoma

23. A 54-year-old woman has experienced nausea with vomiting and early satiety for the past 7 months.
On physical examination, she is afebrile and has no lymphadenopathy a hepatosplenomegaly. CBC
shows hemoglobin, 12.9 g/dL; hematocrit, 41.9 %; platelet count, 263,000/mm3; and WBC count,
8430/mm3. An upper gastrointestinal endoscopy shows loss of the rugal folds of the stomach over a 4 x
8 cm area of the fundus. Gastric biopsy specimens reveal the presence of Helicobacter pylori organisms
in the mucus overlying superficial epithelial cells. There are extensive mucosal and submucosal
monomorphous infiltrates of small lymphocytes, which are CD19+ and CD20+, but CD3 After treatment
of the H. pylori infection, her condition improves. What is the most likely diagnosis?

A. Acute lymphoblastie loukamia

B. Chronic lymphocytic leukemia

C. Diffuse large B-cell lymphoma

D. Follicular Lymphoma

E. Hodgkin Lymphoma, Mixed

F. MALT (marginal zone) Lymphoma

24. A 63-year-old man has noticed a lump in his neck for 2 months. Examination reveals a group of three
discrete nontender right posterior cervical lymph nodes, and a mass of enlarged right axillary lymph
nodes. Chest and abdominal CT scans show mediastinal lymphadenopathy and hepatosplenomegaly.
Microscopic examination of a cervical lymph node blopsy reveals abundant large CD15+ and CD30+
binucleate cells with prominent acidophilic nucleoli, scattered within a sparse lymphocytic infiltrate.
What is molecular analysis of this lesion most likely to reveal?

A. Clonal EBV integration in the large cells

B. BCL6 gene rearrangements in the large cells

C. Deletions of Sq in all the cells

D. Helicobacter pylori infection in all the cells

E. JAK2 gene mutations in the lymphocytes

25. 33-year-old man has experienced multiple nosebleeds along with bleeding gums for th past month.
On examination, his temperature is 37.3* C. He has multiple cutaneous ecchymoses. Laboratory studies
show hemoglobin, 8.5 g/dL; hematocrit, 25.7%; platele count, 13,000/mm3; and WBC count,
52,100/mm3 with 5% segmented neutrophils, 59 bands, 2% myelocytes, 83% blasts, 3% lymphocytes,
and 2% monocytes. Examination a his peripheral blood smear shows the blasts have delicate nuclear
chromatin along wit fine cytoplasmic azurophilic granules. These blasts are CD33+. Which of the
following morphologic findings is most likely to be present on his peripheral blood smear?

A. Auer rods

B. Dohle bodies

C. Hairy projections

D. Heinz bodies

E. Sickle cells

F. Toxic granulations

26. A 22-year-old university student reports easy fatigability of 2 months' duration. On physical
examination, she has no hepatosplenomegaly or lymphadenopathy. Mucosal gingival hemorrhages are
noted. CBC shows hemoglobin, 9.5 g/dL; hematocrit, 28.2%; MCV, 94 um3; platelet count, 20,000/mm3;
and WBC count, 107,000/mm3. Her peripheral blood smear is shown in the figure, and these cells
contain peroxidase positive granules. A bone marrow biopsy specimen shows 100% cellularity with few
residual normal hematopoietic cells. Which of the following is the most likely diagnosis

A. Acute lymphoblastic leukemia

B. Acute myelogenous leukemia

C. Chronic lymphocytic leukemia

D. Chronic myelogenous leukemia

E. Hodgkin lymphoma
27. In an experiment, cell samples are collected from the bone marrow aspirates of patien who were
diagnosed with lymphoproliferative disorders. Cytogenetic analyses are performed on these cells, and a
subset of the cases is found to have the BCR-ABL fusion gene from the reciprocal translocation t(9;22)
(q34;11). The presence of this gene resull in increased tyrosine kinase activity. Patients with which of the
following conditions an most likely to have this gene?

A- acute promyelocytic leukemia

B- Chronic myelogenous leukemia

C- Follicular lymphoma

D- Hodgkin lymphoma, lymphocyte depletion type

E- Multiple Myeloma

28. A 63-year-old woman experiences a burning sensation in her hands and feet. Two months ago, she
had an episode of swelling with tenderness in the right leg, followed by dyspnea and right-sided chest
pain. On physical examination, the spleen and liver now appear to be enlarged. CBC shows hemoglobin,
13.3 g/dL; hematocrit, 40.1%; MCV, 91 um3; platelet count, 657,000/mm3; and WBC count,
17,400/mm3. The peripheral blood smear shows abnormally large platelets. Which of the following is
the most likely diagnosis?

A. Acute myelogenous leukemia

B. Chronic myelogenous leukemia

C. Essential thrombocytosis

D. Myelofibrosis with myeloid metaplasia

E. Polycythemia vera

29. A 50-year-old man has had headache, dizziness, and fatigue for the past 3 months. His friends have
been commenting about his increasingly ruddy complexion. He also has experienced generalized and
severe pruritus, particularly when showering. He notes that his stools are dark. On physical examination,
he is afebrile, and his blood pressure is 165/95 mm Hg. There is no hepatosplenomegaly or
lymphadenopathy. A stool sample is positive for occult blood. CBC shows hemoglobin, 22.3 g/dL;
hematocrit, 67.1%; MCV, 94 um3; platelet count, 453,000/mm3; and WBC count, 7800/mm3. What is
the most likely diagnosis?

A Chronic myelogenous leukemia

B. Erythroleukemia

C Essential thrombocytosis
D. Myelodysplastic syndrome

E. Polycythemia vera

30. A 65-year-old man has experienced worsening fatigue for the past 5 months. On physical
examination, he is afebrile and has a pulse of 91/min, respirations of 18/min, and blood pressure of
105/60 mm Hg. There is no organomegaly. A stool sample is positive for occult blood. Laboratory
findings include hemoglobin of 5.9 g/dL, hematocrit of 18.3%, MCV of 99 um3, platelet count of
250,000/mm3, and WBC count of 7800/mm3. The reticulocyte concentration is 3.9%. No fibrin split
products are detected, and direct and indirect Coombs test results are negative. A bone marrow biopsy
specimen shows marked erythroid hyperplasia. Which of the following conditions best explains these
findings?

A. Aplastic anemia

B. Autoimmune hemolytic anemia

C. Chronic blood loss

D. Iron deficiency anemia

E. Metastatic carcinoma

31. A 28-year-old woman has had a constant feeling of lethargy since childhood. On physical
examination, she is afebrile and has a pulse of 80/min, respirations of 15/min, and blood pressure of
110/70 mm Hg. The spleen tip is palpable, but there is no abdominal pain or tenderness. Laboratory
studies show hemoglobin of 11.7 g/dL, platelet count of 159,000/ mm3, and WBC count of 5390/mm3.
The peripheral blood smear shows small round erythrocytes that lack a zone of central pallor. An
inherited abnormality in which of the following RBC components best accounts for these findings?

A. a-Globin chain

B. B-Globin chain

C. Carbonic anhydrase

D. Glucose-6-phosphate dehydrogenase

E. Heme with porphyrin ring

F. Spectrin cytoskeletal protein

32. A 32-year-old woman from Hanoi, Vietnam, gives birth at 34 weeks' gestation to a markedly
hydropic stillborn male infant. Autopsy findings include hepatosplenomegaly and cardiomegaly, serous
effusions in all body cavities, and gen-eralized hydrops. No congenital anomalies are noted. There is
marked extramedullary hematopoiesis in visceral organs. Which of the following hemoglobins is most
likely predominant on hemoglobin electrophoresis of the fetal RBCS?

A. Hemoglobin A1

B. Hemoglobin A2

C. Hemoglobin Bart's

D. Hemoglobin E

E. Hemoglobin F

F. Hemoglobin H

33. A 12-year-old boy has a history of episodes of severe abdominal, chest, and back pain since early
childhood. On physical examination, he is afebrile, and there is no organomegaly. Laboratory studies
show hemoglobin of 11.2 g/dL, platelet count of 194,000/mm3, and WBC count of 9020/mm3. The
peripheral blood smear shows occasional sickled cells, nucleated RBCS, and Howell-Jolly bodies.
Hemoglobin electrophoresis shows 1% hemoglobin A2, 6% hemoglobin F, and 93% hemoglobin S.
Hydroxyurea therapy is found to be beneficial in this patient. An increase in which of the following is the
most likely basis for its therapeutic efficacy?

A. Erythrocyte production

B. Overall globin chain synthesis

C. Oxygen affinity of hemoglobin

D. Production of hemoglobin A

E. Production of hemoglobin F

34. A 25-year-old woman has a 3-year history of arthralgias. Physical examination shows no joint
deformity, but she appears pale. Laboratory studies show total RBC count of 4.7 million/mm3,
hemoglobin of 12.5 g/dL, hematocrit of 37.1%, platelet count of 217,000/mm3, and WBC count of
5890/mm3. The peripheral blood smear shows hypochromic and microcytic RBCS. Total serum iron and
ferritin levels are normal. Hemoglobin electrophoresis shows 93% hemogiobin A1 with elevated
hemoglobin A2 level of 5.8% and hemoglobin F level of 1.2%. What is the most likely diagnosis?

A. Anemia of chronic disease

B. Autoimmune hemolytic anemia

C. B-Thalassemia minor

D. Infection with Plasmodium vivax

E. Iron deficiency anemia

35. A 23-year-old African-American man passes dark reddish brown urine 3 days after taking an anti-
inflammatory medication that includes phenacetin. He is surprised, because he has been healthy all his
life and has had no major illnesses. On physical examination, he is afebrile, and there are no remarkable
findings. CBC shows a mild normocytic anemia, but the peripheral blood smear shows precipitates of
denatured globin (Heinz bodies) with supravital staining and scattered "bite cells" in the population of
RBCS. Which of the following is the most likely diagnosis?

A. a-Thalassemia minor B.

B-Thalassemia minor

C. Glucose-6-phosphate dehydrogenase deficiency

D. Sickle cell trait

E. Abnormal ankyrin in RBC cytoskeletal membrane

F. Warm antibody autoimmune hemolytic anemia

36. A 16-year-old boy notes passage of dark urine. He has a history of multiple bacterial infections and
venous thromboses for the past 10 years, including portal vein thrombosis in the previous year. On
physical examination, his right leg is swollen and tender. CBC shows hemoglobin, 9.8 g/dl; hematocrit,
29.9%; MCV, 92 um3; platelet count, 150,000/mm3; and WBC count, 3800/mm3 with 24% segmented
neutrophils, 1% bands, 64% lymphocytes, 10% monocytes, and 1% eosinophils. He has a reticulocytosis,
and his serum haptoglobin level is very low. A mutation affecting which of the following gene products is
most likely to give rise to this clinical condition?

A. B-Globin chain

B. Factor V

C. Glucose-6-phosphate dehydrogenase

D. Phosphatidylinositol glycan A (PIGA)

E. Prothrombin G20210A F. Spectrin

37. A 37-year-old woman has experienced abdominal pain and intermittent low-volume diarrhea for the
past 3 months. On physical examination, she is afebrile. A stool sample is positive for occult blood. A
colonoscopy is performed, and biopsy specimens from the terminal ileum and colon show microscopic
findings consistent with Crohn disease. She does not respond to medical therapy, and part of the colon
and terminal ileum are removed. She is transfused with 2 U of packed RBCS during surgery. Three weeks
later, she appears healthy, but complains of easy fatigability. On investigation, CBC findings show
hemoglobin of 10.6 g/dl, hematocrit of 31.6%, RBC count of 2.69 million/ul, MCV of 118 um3, platelet
count of 378,000/mm3, and WBC count of 9800/mm3. The reticulocyte count is 0.3%. Which of the
following is most likely to produce these hematologic findings?

A. Anemia of chronic disease

B. Chronic blood loss

C Hemolytic anemia

D. Myelophthisic anemia

E Vitamin b12 deficiency

38. A 30-year-old man has had pain and burning on urination for the past week. On physical
examination, he is febrile and has a pulse of 92/min, respirations of 18/min, and blood pressure of 80/45
mm Hg. Digital rectal examination indicates that he has an enlarged, tender prostate. There is
costovertebral angle tenderness on the right. Scattered ecchymoses are present over the trunk and
extremities. Laboratory studies showa blood culture positive for Klebsiella pneumoniae. The appearance
of the RBCS in a peripheral blood smear is shown in the figure. Which of the following hematologic
disorders is he most likely to have?

A. Autoimmune hemolytic anemia

B. Hereditary spherocytosis

C. Iron deficiency anemia

D. Megaloblastic anemia

E. Microangiopathic hemolytic anemia

39. 37-year-old woman has noted an excessively heavy menstrual flow each of the past 6 months. She
also has noticed increasing numbers of pinpoint hemorrhages on her lower extremities in the past
month. Physical examination shows no organomegaly or lymphadenopathy. CBC shows hemoglobin of
14.2 g/dL, hematocrit of 42.5%, MCV of 91 um3, platelet count of 15,000/mm3, and WBC count of
6950/mm3. On admission to the hospital, she has melena and after a transfusion of platelets, her
platelet count does not increase. Which of the following describes the most likely basis for her bleeding
tendency?

A. Abnormal production of platelets by megakaryocytes

B. Defective platelet-endothelial interactions

C. Destruction of antibody-coated platelets by the spleen

D. Excessive loss of platelets in menstrual blood

E. Suppression of pluripotent stem cell division

40. A 23-year-old woman in her 25th week of pregnancy has felt no fetal movement for the past 3 days.
Three weeks later, she still has not given birth and suddenly develops dyspnea with cyanosis. On
physical examination, her temperature is 37" C, pulse is 106/min, respirations are 23/min, and blood
pressure is 80/40 mm Hg. She has large ecchymoses over the skin of her entire body. A stool sample is
positive for occult blood. Laboratory studies show an elevated prothrombin time and partial
thromboplastin time. The platelet count is decreased, plasma fibrinogen is markedly decreased, and
fibrin split products are detected. A blood culture is negative. Which of the following is the most likely
cause of her bleeding diathesis?

A. Consumption of coagulation factors

B Defects in platelet aggregation

C Increased vascular fragility

D. Reduced production of platelets

E Texic injury to the endothelium