MLS Treatment Planning & Management 2 — Questions and Answers
Question 1: A patient with iron deficiency anemia is prescribed oral ferrous sulfate. Which laboratory parameter is the BEST indicator of early treatment response?
- Hemoglobin level
- Reticulocyte count (Correct answer)
- Serum ferritin
- Mean corpuscular volume
Correct answer: Reticulocyte count
Reticulocyte count rises within 3–5 days of starting iron therapy, making it the earliest measurable response to treatment.
Question 2: A patient on warfarin therapy has an INR of 5.8 with no active bleeding. According to standard management guidelines, the MOST appropriate action is to:
- Administer fresh frozen plasma immediately
- Hold warfarin doses and recheck INR in 24–48 hours (Correct answer)
- Administer vitamin K 10 mg IV
- Continue current warfarin dose and recheck in one week
Correct answer: Hold warfarin doses and recheck INR in 24–48 hours
For an elevated INR (4.5–10) without bleeding, guidelines recommend withholding warfarin and rechecking rather than routine vitamin K administration.
Question 3: Which heparin monitoring test is used specifically to guide unfractionated heparin (UFH) therapy in patients with antiphospholipid syndrome?
- Anti-Xa assay (Correct answer)
- aPTT
- Thrombin time
- ACT (activated clotting time)
Correct answer: Anti-Xa assay
Anti-Xa assay is preferred for UFH monitoring in antiphospholipid syndrome because lupus anticoagulant can falsely prolong the aPTT, making it unreliable.
Question 4: A bone marrow transplant patient develops a CBC showing WBC 0.2 × 10³/µL, platelet count 8 × 10³/µL, and Hgb 7.1 g/dL on day 10 post-transplant. This finding is MOST consistent with:
- Graft-versus-host disease
- Expected engraftment nadir (Correct answer)
- Acute graft rejection
- Cytomegalovirus infection
Correct answer: Expected engraftment nadir
Pancytopenia around day 10–14 post-transplant represents the expected nadir before donor stem cell engraftment begins producing new blood cells.
Question 5: A patient receiving methotrexate therapy for rheumatoid arthritis has a serum creatinine of 2.4 mg/dL. The MOST important clinical concern related to this finding is:
- Increased risk of methotrexate toxicity due to reduced renal clearance (Correct answer)
- Need for dose reduction of corticosteroids
- Risk of folate-independent myelosuppression
- Reduced efficacy of methotrexate therapy
Correct answer: Increased risk of methotrexate toxicity due to reduced renal clearance
Methotrexate is renally cleared; impaired kidney function leads to drug accumulation, increasing risk of bone marrow suppression and mucositis.
Question 6: Which laboratory finding would prompt a clinician to SWITCH from oral to IV vancomycin when treating Clostridioides difficile (C. diff) infection?
- Stool culture showing high toxin load
- Evidence of ileus or toxic megacolon on imaging (Correct answer)
- C. diff PCR cycle threshold below 25
- WBC greater than 15 × 10³/µL
Correct answer: Evidence of ileus or toxic megacolon on imaging
Ileus or toxic megacolon impairs oral drug delivery to the colon, necessitating IV metronidazole plus rectal vancomycin or other escalation strategies.
Question 7: A patient with chronic kidney disease (CKD stage 4) has a hemoglobin of 9.2 g/dL and serum ferritin of 180 ng/mL with transferrin saturation of 18%. The treatment of choice is:
- Oral iron supplementation alone
- Erythropoiesis-stimulating agent (ESA) without iron
- IV iron supplementation followed by reassessment (Correct answer)
- Red blood cell transfusion
Correct answer: IV iron supplementation followed by reassessment
TSAT below 20% in CKD anemia indicates functional iron deficiency; IV iron is preferred over oral due to impaired GI absorption and superior bioavailability.
MLS Treatment Planning & Management 2
A patient with iron deficiency anemia is prescribed oral ferrous sulfate.
Which laboratory parameter is the BEST indicator of early treatment response?